Healthcare Provider Details

I. General information

NPI: 1750734927
Provider Name (Legal Business Name): PAIN DIAGNOSIS AND TREATMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2016
Last Update Date: 08/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6001 AIRPORT BLVD
MOBILE AL
36608-3142
US

IV. Provider business mailing address

6001 AIRPORT BLVD
MOBILE AL
36608-3142
US

V. Phone/Fax

Practice location:
  • Phone: 251-342-0001
  • Fax: 251-342-0002
Mailing address:
  • Phone: 251-342-0001
  • Fax: 251-342-0002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RALPH LEE IRVIN
Title or Position: PRESIDENT/ PHYSICIAN
Credential: MD
Phone: 251-342-0001