Healthcare Provider Details

I. General information

NPI: 1518303593
Provider Name (Legal Business Name): INTEGRATED PAIN MANAGEMENT OF ALABAMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/16/2013
Last Update Date: 05/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7860 COTTAGE HILL RD STE A
MOBILE AL
36695-4102
US

IV. Provider business mailing address

PO BOX 8159
MOBILE AL
36689-0159
US

V. Phone/Fax

Practice location:
  • Phone: 606-584-8842
  • Fax:
Mailing address:
  • Phone: 251-414-5810
  • Fax: 251-414-5809

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: LLOYD ANDREW MANCHIKES
Title or Position: MEDICAL DIRECTOR
Credential: MD
Phone: 606-584-8842