Healthcare Provider Details

I. General information

NPI: 1053954545
Provider Name (Legal Business Name): MULTIMODALITY PAIN & WELLNESS CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 10/28/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

423 CENTRAL AVE
COLDWATER MS
38618-3915
US

IV. Provider business mailing address

PO BOX 1060
COLDWATER MS
38618-1060
US

V. Phone/Fax

Practice location:
  • Phone: 662-294-2241
  • Fax: 662-622-0257
Mailing address:
  • Phone: 662-294-2241
  • Fax: 662-622-0257

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. AMIT B. PATEL
Title or Position: MD
Credential:
Phone: 901-486-1762