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General NPI Number Information
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NPI Number | 1003629767
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Entity Type | Organization
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Legal Business Name | PAIN TREATMENT CENTERS OF AMERICA, PLLC
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Dates
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Enumeration Date | 01/28/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 7620 CLARINGTON CV STE B
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City | SOUTHAVEN
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State | MS
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Zip | 38671-5648
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Country | US
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Telephone | 844-215-0731
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Fax | 210-526-3087
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Provider Business Mailing Address
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Address Line | 108 N SHACKLEFORD RD
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City | LITTLE ROCK
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State | AR
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Zip | 72211-2840
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Country | US
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Telephone | 501-900-8770
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Fax | 210-526-3087
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Authorized Official
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Title or Position | CREDENTIALING DIRECTOR
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Name | LISA KENT
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Credential |
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Telephone | 501-900-8770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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