Organization
NORTHSHORE INTERVENTIONAL PAIN MANAGEMENT
Active
Other names
Premier Pain Center
Organization subpart
No
Provider details
NPI number
Authorized official
MACKENZIE HAHN (NCPDP COORDINATOR)
(479) 636-9702
Entity
Organization
Contact information
Practice address
7015 HWY 190 E SERVICE RD., STE 101, COVINGTON, LA 70433
(479) 636-9702
(877) 427-2307
Mailing address
PO BOX 3328, BENTONVILLE, AR 72712
(479) 636-9702
(877) 427-2307
Taxonomy
Speciality
Code
Description
License number
State
332900000X
Non-Pharmacy Dispensing Site
Primary
MD.020506
LA
Other
Enumeration date
11/29/2017
Last updated
11/29/2017
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