Charles H. Tadlock, M.D. LTD.

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

License

26067 Issued in AZ

Legal business name

CHARLES H. TADLOCK, M.D. LTD.

Doing business as

Center for Pain Management

Practice address

1912 Miami Ave
Kingman, AZ 86401-4127

Phone

(702) 474-0200

Fax

(702) 946-5328

NPI assigned

Jun 27, 2008

Last updated

Feb 18, 2014By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Tammy R Shaffer

Title

Administrator

Phone

(702) 474-0200

Specialties & licenses 3

Addresses

Other identifiers 5

Other names 1

• CENTER FOR PAIN MANAGEMENT Doing business as

Locations

Practitioners 3

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Michael Gene Valpiani, M.D.

  • Pain Medicine Physician
  • Kingman, AZ
  • NPI 1346235355
  NPD (past)
• James A. Boesiger, PA-C

  • Medical Physician Assistant
  • Las Vegas, NV
  • NPI 1104804756
  NPD (past)
• Gerald Dean Jones, PA-C

  • Physician Assistant
  • North Las Vegas, NV
  • NPI 1508159989
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1214524800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1392681600000",
    "number": "1548422876",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6725 S EASTERN AVE",
            "address_2": "SUITE 6",
            "city": "LAS VEGAS",
            "state": "NV",
            "postal_code": "891193916",
            "telephone_number": "702-474-0200",
            "fax_number": "702-946-5328"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1912 MIAMI AVE",
            "city": "KINGMAN",
            "state": "AZ",
            "postal_code": "864014127",
            "telephone_number": "702-474-0200",
            "fax_number": "702-946-5328"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CHARLES H. TADLOCK, M.D. LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2008-06-27",
        "last_updated": "2014-02-18",
        "status": "A",
        "authorized_official_last_name": "SHAFFER",
        "authorized_official_first_name": "TAMMY",
        "authorized_official_middle_name": "R",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "702-474-0200",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "AZ",
            "license": "4873",
            "primary": false
        },
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "AZ",
            "license": "AP4247",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AZ",
            "license": "26067",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "RR MEDICARE",
            "identifier": "720000127",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE INDIVIDUAL PIN (TADLOCK)",
            "identifier": "35714",
            "state": "AZ"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "069618",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN JULIE BROWN, FNP",
            "identifier": "Z149395",
            "state": "AZ"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICARE PIN GERALD JONES, PA-C",
            "identifier": "Z146133",
            "state": "AZ"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "CENTER FOR PAIN MANAGEMENT",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Mark C Carter, M.D.
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• Annie Myowin Chang-Burns, M.D.
• David Scott Charon, D.M.D.
• Taylor Chase
• Louis Koon Chaw, PHARMD
• Tara Lynne Chay, SLP
• Anselm Nnamdi Chinyere, PHARMD

• Pain Medicine (Anesthesiology) Physician in Kingman, AZ
• Providers in Kingman, AZ by specialty
• Pain Medicine (Anesthesiology) Physician in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 18, 2014; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.