Basic Information
| Provider Information | |||||||||
| NPI: | 1841619731 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN TREATMENT CENTERS OF AMERICA, PLLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3805 MCCAIN PARK DR | ||||||||
| Address2: | SUITE 105 | ||||||||
| City: | NORTH LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721167803 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017714693 | ||||||||
| FaxNumber: | 5017714885 | ||||||||
| Practice Location | |||||||||
| Address1: | 8907 KANIS RD | ||||||||
| Address2: | SUITE 400 | ||||||||
| City: | LITTLE ROCK | ||||||||
| State: | AR | ||||||||
| PostalCode: | 722056449 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5017714693 | ||||||||
| FaxNumber: | 5017714885 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/08/2014 | ||||||||
| LastUpdateDate: | 05/26/2020 | ||||||||
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| AuthorizedOfficialLastName: | SIDDIQUI | ||||||||
| AuthorizedOfficialFirstName: | MERAJ | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 5017714693 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 05/26/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QM1300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty |
No ID Information.