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General NPI Number Information
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NPI Number | 1558475806
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Entity Type | Organization
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Legal Business Name | STAT CARE PAIN MANAGEMENT, LLC
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Dates
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Enumeration Date | 08/17/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 807 STUBB ST. SUITE 1
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City | MONROE
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State | LA
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Zip | 71201
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Country | US
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Telephone | 318-387-1059
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Fax | 318-387-1093
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Provider Business Mailing Address
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Address Line | PO BOX 1725
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City | KENNER
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State | LA
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Zip | 70063-1725
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Country | US
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Telephone | 504-469-1960
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Fax | 504-469-1979
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Authorized Official
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Title or Position | CO MANAGER
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Name | TIFFANY MILLER
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Credential |
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Telephone | 318-387-1059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | 077368
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License Number State | LA
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