Basic Information
| Provider Information | |||||||||
| NPI: | 1306839196 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | ABDUL NAUSHAD MD PC | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | ADVANCED PAIN CENTER | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 622 COLLINS DR | ||||||||
| Address2: | STE. 200 | ||||||||
| City: | FESTUS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 630282077 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366381506 | ||||||||
| FaxNumber: | 6366381507 | ||||||||
| Practice Location | |||||||||
| Address1: | 2865 JAMES BLVD | ||||||||
| Address2: | |||||||||
| City: | POPLAR BLUFF | ||||||||
| State: | MO | ||||||||
| PostalCode: | 639012803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6366381506 | ||||||||
| FaxNumber: | 6366381507 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/26/2005 | ||||||||
| LastUpdateDate: | 03/08/2017 | ||||||||
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| AuthorizedOfficialLastName: | NAUSHAD | ||||||||
| AuthorizedOfficialFirstName: | ABDUL | ||||||||
| AuthorizedOfficialMiddleName: | N | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6366381506 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | |||||||||
| AuthorizedOfficialCredential: | M.D. | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | MO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 2081P2900X | MO | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine | 208VP0000X | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 1306839196 | 05 | MO | MEDICAID | 197806 | 01 | MO | BLUE CROSS BLUE SHIELD | OTHER | 000000471330 | 01 | MO | BCBS | OTHER | 567896 | 01 | MO | HEALTHLINK | OTHER |