Healthcare Provider Details

I. General information

NPI: 1598736183
Provider Name (Legal Business Name): PAIN MANAGEMENT & ANESTHESIOLOGY ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2006
Last Update Date: 01/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 RANDOLPH RD
CHARLOTTE NC
28211-1075
US

IV. Provider business mailing address

PO BOX 5615
FRESNO CA
93755-5615
US

V. Phone/Fax

Practice location:
  • Phone: 704-377-1647
  • Fax: 559-354-4235
Mailing address:
  • Phone: 800-436-1018
  • Fax: 559-354-4235

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNC
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number
License Number StateNC
# 3
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNC

VIII. Authorized Official

Name: DR. CHARLES DAVID HORD
Title or Position: PARTNER
Credential: M.D.
Phone: 704-377-1647