Healthcare Provider Details

I. General information

NPI: 1861876252
Provider Name (Legal Business Name): THE CENTER FOR PAIN OF MONTGOMERY PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 07/15/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2065 E SOUTH BLVD STE 401
MONTGOMERY AL
36116-2462
US

IV. Provider business mailing address

PO BOX 241348
MONTGOMERY AL
36124-1348
US

V. Phone/Fax

Practice location:
  • Phone: 334-288-7808
  • Fax:
Mailing address:
  • Phone: 334-288-7808
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-119421
License Number StateAL

VIII. Authorized Official

Name: DR. BRADLEY KATZ
Title or Position: PRINCIPAL
Credential: MD
Phone: 334-288-7808