Healthcare Provider Details

I. General information

NPI: 1740946573
Provider Name (Legal Business Name): PAIN TREATMENT CENTERS OF AMERICA, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/16/2021
Last Update Date: 11/16/2021
Certification Date: 11/16/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

29 S FOURTH ST
ROLLING FORK MS
39159-5146
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 TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: KRISTEN NEHK
Title or Position: CHIEF BILLING OPERATING OFFICER
Credential:
Phone: 951-541-6889