Basic Information
| Provider Information | |||||||||
| NPI: | 1518303593 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRATED PAIN MANAGEMENT OF ALABAMA LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 8159 | ||||||||
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| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366890159 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2514145810 | ||||||||
| FaxNumber: | 2514145809 | ||||||||
| Practice Location | |||||||||
| Address1: | 7860 COTTAGE HILL RD | ||||||||
| Address2: | STE A | ||||||||
| City: | MOBILE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 366954102 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6065848842 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/16/2013 | ||||||||
| LastUpdateDate: | 05/16/2013 | ||||||||
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| AuthorizedOfficialLastName: | MANCHIKES | ||||||||
| AuthorizedOfficialFirstName: | LLOYD | ||||||||
| AuthorizedOfficialMiddleName: | ANDREW | ||||||||
| AuthorizedOfficialTitleorPosition: | MEDICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 6065848842 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 208VP0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.