Organization
CHARLES H. TADLOCK, M.D. LTD.
Active
Other names
CENTER FOR PAIN MANAGEMENT
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. TAMMY R SHAFFER (ADMINISTRATOR)
(702) 474-0200
Entity
Organization
Contact information
Practice address
1912 MIAMI AVE, KINGMAN, AZ 86401-4127
(702) 474-0200
(702) 946-5328
Mailing address
6725 S EASTERN AVE, SUITE 6, LAS VEGAS, NV 89119-3916
(702) 474-0200
(702) 946-5328
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
26067
AZ
363AM0700X
Medical Physician Assistant
4873
AZ
363LF0000X
Family Nurse Practitioner
AP4247
AZ
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
069618
—
AZ
01
—
35714
MEDICARE INDIVIDUAL PIN (TADLOCK)
AZ
01
—
720000127
RR MEDICARE
AZ
01
—
Z146133
MEDICARE PIN GERALD JONES, PA-C
AZ
01
—
Z149395
MEDICARE PIN JULIE BROWN, FNP
AZ
Enumeration date
06/27/2008
Last updated
02/18/2014
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