=====================================================
General NPI Number Information
=====================================================
NPI Number | 1255778577
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ALABAMA SPINE AND PAIN
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/28/2013
-----------------------------------------------------
Last Update Date | 12/29/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3907 PEACH ST
-----------------------------------------------------
City | FLORENCE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35630-2803
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-712-2422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 998
-----------------------------------------------------
City | KILLEN
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35645-0998
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-712-2422
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER / PHYSICIAN
-----------------------------------------------------
Name | PAVAN TELANG
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 256-712-2422
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | MD.32531
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------