Healthcare Provider Details

I. General information

NPI: 1639340904
Provider Name (Legal Business Name): ALABAMA PAIN CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/14/2008
Last Update Date: 03/14/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 WHITESPORT DRIVE
HUNTSVILLE AL
35801-6495
US

IV. Provider business mailing address

600 WHITESPORT DRIVE
HUNTSVILLE AL
35801
US

V. Phone/Fax

Practice location:
  • Phone: 256-882-2003
  • Fax: 256-882-7115
Mailing address:
  • Phone: 256-882-2003
  • Fax: 256-882-7115

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number895
License Number StateAL

VIII. Authorized Official

Name: MRS. BARBARA L MCGOUGH
Title or Position: BILLING DIRECTOR
Credential:
Phone: 256-705-4405