Provider Demographics
NPI:1225428261
Name:PAIN SPECIALISTS OF GADSDEN, INC
Entity type:Organization
Organization Name:PAIN SPECIALISTS OF GADSDEN, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:
Authorized Official - Last Name:JACOBS-MURATTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:256-492-7246
Mailing Address - Street 1:1026 GOODYEAR AVE
Mailing Address - Street 2:BLD 400 SUITE 301
Mailing Address - City:GADSDEN
Mailing Address - State:AL
Mailing Address - Zip Code:35903-1102
Mailing Address - Country:US
Mailing Address - Phone:256-492-7246
Mailing Address - Fax:
Practice Address - Street 1:1026 GOODYEAR AVE
Practice Address - Street 2:BLD 400 SUITE 301
Practice Address - City:GADSDEN
Practice Address - State:AL
Practice Address - Zip Code:35903-1102
Practice Address - Country:US
Practice Address - Phone:256-492-7246
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-29
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3267261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain