Provider Demographics
NPI:1063445542
Name:TOTAL PAIN CARE LLC
Entity type:Organization
Organization Name:TOTAL PAIN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT TOTAL PAIN CARE LLC
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:E
Authorized Official - Last Name:STAGGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:601-482-9224
Mailing Address - Street 1:PO BOX 711
Mailing Address - Street 2:
Mailing Address - City:MERIDIAN
Mailing Address - State:MS
Mailing Address - Zip Code:39302-0711
Mailing Address - Country:US
Mailing Address - Phone:601-703-3076
Mailing Address - Fax:601-703-4586
Practice Address - Street 1:1001 14TH STREET
Practice Address - Street 2:
Practice Address - City:MERIDIAN
Practice Address - State:MS
Practice Address - Zip Code:39301
Practice Address - Country:US
Practice Address - Phone:601-703-3076
Practice Address - Fax:601-703-4586
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS20248443OtherBCBS MISSISSIPPI
ALASC0076CMedicaid
MS20248443OtherBCBS MISSISSIPPI