Provider Demographics
NPI:1699466821
Name:PAIN TREATMENT CENTERS OF AMERICA, PLLC
Entity type:Organization
Organization Name:PAIN TREATMENT CENTERS OF AMERICA, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CBOO
Authorized Official - Prefix:
Authorized Official - First Name:KRISTEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NEHK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:951-541-6889
Mailing Address - Street 1:108 N SHACKLEFORD RD
Mailing Address - Street 2:
Mailing Address - City:LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72211-2840
Mailing Address - Country:US
Mailing Address - Phone:844-215-0731
Mailing Address - Fax:
Practice Address - Street 1:108 N SHACKLEFORD RD
Practice Address - Street 2:
Practice Address - City:LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72211-2840
Practice Address - Country:US
Practice Address - Phone:844-215-0731
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN TREATMENT CENTERS OF AMERICA, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-05-18
Last Update Date:2023-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty