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General NPI Number Information
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NPI Number | 1861876252
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Entity Type | Organization
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Legal Business Name | THE CENTER FOR PAIN OF MONTGOMERY PC
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Dates
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Enumeration Date | 07/15/2015
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Last Update Date | 07/15/2015
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Provider Practice Location Address
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Address Line | 2065 E SOUTH BLVD STE 401
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City | MONTGOMERY
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State | AL
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Zip | 36116-2462
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Country | US
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Telephone | 334-288-7808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 241348
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City | MONTGOMERY
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State | AL
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Zip | 36124-1348
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Country | US
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Telephone | 334-288-7808
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Fax |
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Authorized Official
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Title or Position | PRINCIPAL
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Name | DR. BRADLEY KATZ
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Credential | MD
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Telephone | 334-288-7808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LA2200X
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Taxonomy Name | Adult Health Nurse Practitioner
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License Number | 1-119421
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License Number State | AL
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