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General NPI Number Information
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NPI Number | 1225096613
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CTR MERIDIAN
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Dates
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Enumeration Date | 05/03/2006
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Last Update Date | 05/21/2013
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Provider Practice Location Address
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Address Line | 1102 CONSTITUTION AVE
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City | MERIDIAN
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State | MS
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Zip | 39301-4001
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Country | US
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Telephone | 601-703-5600
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 228
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City | WEARE
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State | NH
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Zip | 03281-0228
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Country | US
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Telephone | 601-681-4985
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Fax | 603-529-5981
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Authorized Official
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Title or Position | PRESIDENT
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Name | AZHAR M PASHA
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Credential |
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Telephone | 601-703-5600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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