=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922764018
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN AND REHABILITATION CONSULTANTS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 11/12/2021
-----------------------------------------------------
Last Update Date | 08/01/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 E MCKINNEY AVE
-----------------------------------------------------
City | ALBERTVILLE
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35950-1828
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-464-7855
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8000 MADISON BLVD # D102-291
-----------------------------------------------------
City | MADISON
-----------------------------------------------------
State | AL
-----------------------------------------------------
Zip | 35758-2031
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 256-464-7855
-----------------------------------------------------
Fax | 855-301-8314
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | MD/OWNER
-----------------------------------------------------
Name | NORMAN EUGENE MCCOOMER
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 256-464-7855
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2081P2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------