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General NPI Number Information
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NPI Number | 1518303593
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Entity Type | Organization
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Legal Business Name | INTEGRATED PAIN MANAGEMENT OF ALABAMA LLC
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Dates
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Enumeration Date | 05/16/2013
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Last Update Date | 05/16/2013
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Provider Practice Location Address
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Address Line | 7860 COTTAGE HILL RD STE A
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City | MOBILE
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State | AL
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Zip | 36695-4102
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Country | US
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Telephone | 606-584-8842
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 8159
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City | MOBILE
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State | AL
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Zip | 36689-0159
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Country | US
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Telephone | 251-414-5810
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Fax | 251-414-5809
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | LLOYD ANDREW MANCHIKES
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Credential | MD
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Telephone | 606-584-8842
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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