NPIMap

Organization Active NPI

Alabama Pain Center, LLC

  • Pain Medicine (Anesthesiology) Physician
  • Huntsville, AL
National Provider Identifier
1831265776
Registry record updated Aug 15, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X
License
12320 Issued in AL
Legal business name
ALABAMA PAIN CENTER, LLC
Practice address
600 Whitesport Drive
Suite a
Huntsville, AL 35801
Phone
(256) 882-2003
Fax
(256) 705-4630
NPI assigned
Nov 24, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 15, 2012

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

Authorized official

Name
Dr. Kenneth Dean Willis, M.D.
Title
Medical Director
Phone
(256) 882-2003

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103TC0700X 895 AL
Pain Medicine (Anesthesiology) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207LP2900X 12320 AL Primary
Nurse PractitionerGroup: 193200000X MULTI-SPECIALTY GROUP 363L00000X 1-075145 AL

Addresses

Primary practice location

600 Whitesport Drive
Suite a
Huntsville, AL 35801

Mailing address

600 Whitesport Drive
Suite a
Huntsville, AL 35801
Phone (256) 882-2003

Other identifiers 1

IdentifierTypeStateIssuer
529908240MedicaidAL

National Provider Directory

National Provider Directory

Member organizations 1

Organizations listed as members of this organization in the National Provider Directory.

Locations

600 Whitesport Cir SW
Huntsville, AL 35801
Phone (256) 429-5622

3322 Memorial Pkwy SW
Ste 423
Huntsville, AL 35801
Phone (256) 428-8232

Practitioners & affiliated clinicians

Practitioners 21

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 21

NPI Registry JSON

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

{
    "created_epoch": "1164326400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1344988800000",
    "number": "1831265776",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "600 WHITESPORT DRIVE",
            "address_2": "SUITE A",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "35801",
            "telephone_number": "256-882-2003",
            "fax_number": "256-705-4630"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "600 WHITESPORT DRIVE",
            "address_2": "SUITE A",
            "city": "HUNTSVILLE",
            "state": "AL",
            "postal_code": "35801",
            "telephone_number": "256-882-2003",
            "fax_number": "256-705-4630"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ALABAMA PAIN CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-24",
        "last_updated": "2012-08-15",
        "status": "A",
        "authorized_official_last_name": "WILLIS",
        "authorized_official_first_name": "KENNETH",
        "authorized_official_middle_name": "DEAN",
        "authorized_official_title_or_position": "MEDICAL DIRECTOR",
        "authorized_official_telephone_number": "256-882-2003",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist, Clinical",
            "state": "AL",
            "license": "895",
            "primary": false
        },
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": "AL",
            "license": "12320",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": "AL",
            "license": "1-075145",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "529908240",
            "state": "AL"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Huntsville, AL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 15, 2012; 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.