Healthcare Provider Details

I. General information

NPI: 1346589736
Provider Name (Legal Business Name): INTERVENTIONAL PAIN SOLUTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/05/2013
Last Update Date: 02/05/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 GADSDEN HWY SUITE 116 - 150
BIRMINGHAM AL
35235-3126
US

IV. Provider business mailing address

1430 GADSDEN HWY SUITE 116 - 150
BIRMINGHAM AL
35235-3126
US

V. Phone/Fax

Practice location:
  • Phone: 205-834-4082
  • Fax:
Mailing address:
  • Phone: 205-834-4082
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number21909
License Number StateAL

VIII. Authorized Official

Name: DR. RICHARD H MAUGHON
Title or Position: OWNER
Credential: MD
Phone: 205-834-4082