Organization
PMCP, PSC
Active
Other names
PAIN MANAGEMENT CENTER OF PADUCAH
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAXMAIAH MANCHIKANTI M.D. (CEO)
(270) 554-8373
Entity
Organization
Contact information
Practice address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987
Mailing address
2831 LONE OAK RD, PADUCAH, KY 42003-8041
(270) 554-8373
(270) 554-8987
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
367500000X
Certified Registered Nurse Anesthetist
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
6592880600
—
KY
Enumeration date
01/09/2007
Last updated
10/05/2011
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