Healthcare Provider Details

I. General information

NPI: 1225096613
Provider Name (Legal Business Name): PAIN MANAGEMENT CTR MERIDIAN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2006
Last Update Date: 05/21/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1102 CONSTITUTION AVE
MERIDIAN MS
39301-4001
US

IV. Provider business mailing address

PO BOX 228
WEARE NH
03281-0228
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-5600
  • Fax:
Mailing address:
  • Phone: 601-681-4985
  • Fax: 603-529-5981

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: AZHAR M PASHA
Title or Position: PRESIDENT
Credential:
Phone: 601-703-5600