Basic Information
| Provider Information | |||||||||
| NPI: | 1740946573 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN TREATMENT CENTERS OF AMERICA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 108 N SHACKLEFORD RD | ||||||||
| Address2: | |||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722112840 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017122571 | ||||||||
| FaxNumber: | 5014047789 | ||||||||
| Practice Location | |||||||||
| Address1: | 29 S FOURTH ST | ||||||||
| Address2: | |||||||||
| City: | ROLLING FORK | ||||||||
| State: | MS | ||||||||
| PostalCode: | 391595146 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017122571 | ||||||||
| FaxNumber: | 5014047789 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/16/2021 | ||||||||
| LastUpdateDate: | 11/16/2021 | ||||||||
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| AuthorizedOfficialLastName: | NEHK | ||||||||
| AuthorizedOfficialFirstName: | KRISTEN | ||||||||
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| AuthorizedOfficialTitleorPosition: | CHIEF BILLING OPERATING OFFICER | ||||||||
| AuthorizedOfficialTelephone: | 9515416889 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| NPICertificationDate: | 11/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207Q00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Family Medicine |
No ID Information.