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General NPI Number Information
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NPI Number | 1376092205
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Entity Type | Organization
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Legal Business Name | ADVANCED INTERVENTIONAL PAIN SURGERY CENTER LLC
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Dates
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Enumeration Date | 10/04/2016
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Last Update Date | 10/04/2016
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Provider Practice Location Address
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Address Line | 1717 MALVERN AVENUE
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City | HOT SPRINGS
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State | AR
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Zip | 71913-6442
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Country | US
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Telephone | 501-321-4772
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Fax | 501-321-2945
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Provider Business Mailing Address
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Address Line | 1717 MALVERN AVENUE
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City | HOT SPRINGS
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State | AR
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Zip | 71913
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Country | US
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Telephone | 501-321-4772
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Fax | 501-321-2945
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. JACOB EDATHARA ABRAHAM
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Credential | MD
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Telephone | 501-655-1335
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number |
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License Number State |
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