# CHARLES H. TADLOCK, M.D. LTD.

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- **Entity:** Organization
- **Status:** Active
- **Other names:** CENTER FOR PAIN MANAGEMENT
- **Organization subpart:** No

## Provider details

- **NPI number:** 1548422876
- **Authorized official:** MRS. TAMMY R SHAFFER (ADMINISTRATOR)
- **Authorized official phone:** (702) 474-0200

## Contact information

- **Practice address:** 1912 MIAMI AVE, KINGMAN, AZ 86401-4127
- **Practice address phone:** (702) 474-0200
- **Practice address fax:** (702) 946-5328
- **Mailing address:** 6725 S EASTERN AVE, SUITE 6, LAS VEGAS, NV 89119-3916
- **Mailing address phone:** (702) 474-0200
- **Mailing address fax:** (702) 946-5328

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | 26067 | AZ | Yes |
| 363AM0700X | Medical Physician Assistant | 4873 | AZ | — |
| 363LF0000X | Family Nurse Practitioner | AP4247 | AZ | — |

## Other

- **Enumeration date:** 06/27/2008
- **Last updated:** 02/18/2014