1255633707 NPI number — PAIN MEDICINE CONSULTANTS, INC.

Table of content: (NPI 1255633707)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255633707 NPI number — PAIN MEDICINE CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MEDICINE CONSULTANTS, INC.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1255633707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N WIGET LN
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-5988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-287-1256
Provider Business Mailing Address Fax Number:
925-287-0931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5924 STONERIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94588-2887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-287-1256
Provider Business Practice Location Address Fax Number:
925-287-0913
Provider Enumeration Date:
12/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHINAMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
925-287-1256

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

Other Provider's Identifiers (legacy, non-NPI)





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