Healthcare Provider Details

I. General information

NPI: 1063445542
Provider Name (Legal Business Name): TOTAL PAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/08/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 14TH STREET
MERIDIAN MS
39301
US

IV. Provider business mailing address

PO BOX 711
MERIDIAN MS
39302-0711
US

V. Phone/Fax

Practice location:
  • Phone: 601-703-3076
  • Fax: 601-703-4586
Mailing address:
  • Phone: 601-703-3076
  • Fax: 601-703-4586

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KENNETH E STAGGS JR.
Title or Position: PRESIDENT TOTAL PAIN CARE LLC
Credential: MD
Phone: 601-482-9224