Provider Demographics
NPI:1801121504
Name:SHEDDEN PAIN RELIEF & SPORTS MEDICINE LLC
Entity type:Organization
Organization Name:SHEDDEN PAIN RELIEF & SPORTS MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:D
Authorized Official - Last Name:SHEDDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:334-702-9445
Mailing Address - Street 1:PO BOX 8365
Mailing Address - Street 2:
Mailing Address - City:DOTHAN
Mailing Address - State:AL
Mailing Address - Zip Code:36304-0365
Mailing Address - Country:US
Mailing Address - Phone:334-702-9445
Mailing Address - Fax:334-702-9465
Practice Address - Street 1:1733 W MAIN ST
Practice Address - Street 2:SUITE 100
Practice Address - City:DOTHAN
Practice Address - State:AL
Practice Address - Zip Code:36301-1330
Practice Address - Country:US
Practice Address - Phone:334-702-9445
Practice Address - Fax:334-702-9465
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-14
Last Update Date:2009-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALDO118207QA0401X, 2081S0010X, 2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction MedicineGroup - Multi-Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL051554243OtherMEDICARE IDENTIFICATION NUMBER