Basic Information
| Provider Information | |||||||||
| NPI: | 1427513654 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN TREATMENT CENTERS OF AMERICA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 N. SHACKLEFORD ROAD | ||||||||
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| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 72211 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5013468116 | ||||||||
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| Practice Location | |||||||||
| Address1: | 511 OAKWOOD BOULEVARD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | ROUND ROCK | ||||||||
| State: | TX | ||||||||
| PostalCode: | 78681 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8667677231 | ||||||||
| FaxNumber: | 8662497552 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2019 | ||||||||
| LastUpdateDate: | 02/01/2019 | ||||||||
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| AuthorizedOfficialLastName: | MCCRARY | ||||||||
| AuthorizedOfficialFirstName: | WILLIAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | CEO | ||||||||
| AuthorizedOfficialTelephone: | 5013468116 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.