Healthcare Provider Details

I. General information

NPI: 1841619731
Provider Name (Legal Business Name): PAIN TREATMENT CENTERS OF AMERICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/08/2014
Last Update Date: 04/03/2025
Certification Date: 04/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

108 N SHACKLEFORD RD
LITTLE ROCK AR
72211-2840
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: 501-404-7789
Mailing address:
  • Phone: 501-712-2571
  • Fax: 501-404-7789

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM1200X
TaxonomyMagnetic Resonance Imaging (MRI) Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MERAJ SIDDIQUI
Title or Position: OWNER
Credential: MD
Phone: 501-771-4693