MEDICARE: TOTAL PAIN SOLUTIONS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	3336C0003X	Community/Retail Pharmacy	PH02514	NV

General Provider Information

NPI Number	:	1154555720
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TOTAL PAIN SOLUTIONS

Provider Business Mailing Address
First Line	:	PO BOX 1829
Second Line	:
City	:	GARDENDALE
State	:	AL
Zip	:	35071-1909
Country	:	US
Telephone Number	:	877-608-4995
Fax Number	:	877-608-2718

Provider Business Practice Location Address
First Line	:	6000 S EASTERN AVE
Second Line	:	BLDG I
City	:	LAS VEGAS
State	:	NV
Zip	:	89119-3125
Country	:	US
Telephone Number	:	205-608-4995
Fax Number	:	702-974-2090

Authorized Official
Title or Position	:	COO
Name	:	MR. BRION BOWMAN
Credential	:
Telephone Number	:	205-608-4995

Provider Enumeration Date	:	05/11/2009
Last Update Date	:	05/11/2009

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