=====================================================
General NPI Number Information
=====================================================
NPI Number | 1891829396
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NORTH ALABAMA PAIN SVCS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1852 BELTLINE RD SW SUITE G
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601-5518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-340-9553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1852 BELTLINE RD SW SUITE G
-----------------------------------------------------
City | DECATUR
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35601-5518
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-340-9553
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OFFICE MANAGER
-----------------------------------------------------
Name | JENNIFER MURPHY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-340-9553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number | 2187
-----------------------------------------------------
License Number State | AL
-----------------------------------------------------