Healthcare Provider Details

I. General information

NPI: 1063995504
Provider Name (Legal Business Name): PAIN TREATMENT CENTERS OF AMERICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/11/2018
Last Update Date: 01/11/2023
Certification Date: 01/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1710 MAYFIELD DR
JONESBORO AR
72401-4563
US

IV. Provider business mailing address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
US

V. Phone/Fax

Practice location:
  • Phone: 501-712-2571
  • Fax: 888-630-8885
Mailing address:
  • Phone: 501-712-2571
  • Fax: 888-630-8885

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN NEHK
Title or Position: COO OF RCM SERVICES
Credential:
Phone: 951-541-6889