1265488308 NPI number — CLINICAL PAIN MANAGEMENT ASSOCIATES, PC

Table of content: (NPI 1265488308)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1265488308 NPI number — CLINICAL PAIN MANAGEMENT ASSOCIATES, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CLINICAL PAIN MANAGEMENT ASSOCIATES, PC
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:
1265488308
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/21/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
333 N OXFORD VALLEY RD
Provider Second Line Business Mailing Address:
SUITE 510
Provider Business Mailing Address City Name:
FAIRLESS HILLS
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19030-2624
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-949-3100
Provider Business Mailing Address Fax Number:
215-949-8521

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
333 N OXFORD VALLEY RD
Provider Second Line Business Practice Location Address:
SUITE 510
Provider Business Practice Location Address City Name:
FAIRLESS HILLS
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19030-2624
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-949-3100
Provider Business Practice Location Address Fax Number:
215-949-8521
Provider Enumeration Date:
05/26/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RIZZO
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
215-785-0145

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 50001468 . This is a "CAPITAL BLUE CROSS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 962740 . This is a "PA BLUE SHIELD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33029 . This is a "KEYSTONE MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: A3190544 . This is a "OXFORD" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DD1386 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0422856000 . This is a "KEYSTONE CENTRAL" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0964596 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DB0435 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0422856000 . This is a "KEYSTONE HEALTH PLAN EAST" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1201547 . This is a "AETNA" identifier , issued by the state of ( NJ ) . This identifiers is of the category "OTHER".
  • Identifier: 962740 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 33029 . This is a "HORIZON MERCY" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0073566950002 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0422856000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com