1306234786 NPI number — PAIN MANAGEMENT CENTERS OF AMERICA, PSC

Table of content: (NPI 1306234786)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1306234786 NPI number — PAIN MANAGEMENT CENTERS OF AMERICA, PSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MANAGEMENT CENTERS OF AMERICA, PSC
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:
6
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:
1306234786
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/11/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1101 PROFESSIONAL BLVD STE 212
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
EVANSVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47714-8016
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-618-3909
Provider Business Mailing Address Fax Number:
812-379-8096

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1101 PROFESSIONAL BLVD
Provider Second Line Business Practice Location Address:
SUITE 212
Provider Business Practice Location Address City Name:
EVANSVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47714
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-618-3909
Provider Business Practice Location Address Fax Number:
812-379-8096
Provider Enumeration Date:
01/07/2015

Additional Information

Authorized Official

Authorized Official Last Name:
SANAPATI
Authorized Official First Name:
MAHENDRA
Authorized Official Middle Name:
R.
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-618-3909

Provider Taxonomy Codes

  • Taxonomy code: 3336H0001X , with the licence number:  60006683A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 60006697A . This is a "STATE BOARD OF PHARMACY" identifier , issued by the state of ( IN ) . This identifiers is of the category "OTHER".




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