Provider Demographics
NPI:1558506881
Name:MEDICAL PAIN MANAGEMENT,PC
Entity type:Organization
Organization Name:MEDICAL PAIN MANAGEMENT,PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAILESH
Authorized Official - Middle Name:P
Authorized Official - Last Name:UPADHYAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-231-1231
Mailing Address - Street 1:PO BOX 1738
Mailing Address - Street 2:
Mailing Address - City:ANNISTON
Mailing Address - State:AL
Mailing Address - Zip Code:36202-1738
Mailing Address - Country:US
Mailing Address - Phone:256-231-1231
Mailing Address - Fax:256-231-1232
Practice Address - Street 1:701 LEIGHTON AVENUE
Practice Address - Street 2:
Practice Address - City:ANNISTON
Practice Address - State:AL
Practice Address - Zip Code:35207-5745
Practice Address - Country:US
Practice Address - Phone:256-231-1231
Practice Address - Fax:256-231-1232
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2008-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL9218207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty