Provider Demographics
NPI:1255778577
Name:ALABAMA SPINE AND PAIN
Entity type:Organization
Organization Name:ALABAMA SPINE AND PAIN
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:PAVAN
Authorized Official - Middle Name:
Authorized Official - Last Name:TELANG
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:256-712-2422
Mailing Address - Street 1:PO BOX 998
Mailing Address - Street 2:
Mailing Address - City:KILLEN
Mailing Address - State:AL
Mailing Address - Zip Code:35645-0998
Mailing Address - Country:US
Mailing Address - Phone:256-712-2422
Mailing Address - Fax:
Practice Address - Street 1:3907 PEACH ST
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:AL
Practice Address - Zip Code:35630-2803
Practice Address - Country:US
Practice Address - Phone:256-712-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-28
Last Update Date:2023-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALMD.32531207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty