1588974588 NPI number — GREATER PHILADELPHIA PAIN MANAGEMENT CENTER PC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1588974588 NPI number — GREATER PHILADELPHIA PAIN MANAGEMENT CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GREATER PHILADELPHIA PAIN MANAGEMENT CENTER 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:
1588974588
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/10/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 LOUIS DRIVE SUITE 202
Provider Second Line Business Mailing Address:
GREATER PHILADELPHIA PAIN MANAGEMENT CENTER PC
Provider Business Mailing Address City Name:
WARMINSTER
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
18974
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-957-5400
Provider Business Mailing Address Fax Number:
215-957-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2612 RHAWN STREET
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHILADELPHIA
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19152
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-338-8555
Provider Business Practice Location Address Fax Number:
215-957-5401
Provider Enumeration Date:
10/12/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAYZICK
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
M
Authorized Official Title or Position:
COO
Authorized Official Telephone Number:
215-957-5400

Provider Taxonomy Codes

  • Taxonomy code: 2081P2900X , with the licence number:  MD425455 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 950467 . This is a "HIGHMARK" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 0872975000 . This is a "KEYSTONE/PC" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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