1801936125 NPI number — PAIN MANAGEMENT COMPANY LLC

Table of content: (NPI 1801936125)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1801936125 NPI number — PAIN MANAGEMENT COMPANY LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MANAGEMENT COMPANY LLC
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:
PMC PHARMACY
Provider Other Organization Name Type Code:
3
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:
1801936125
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/08/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1250 EASTON RD
Provider Second Line Business Mailing Address:
SUITE 201 N
Provider Business Mailing Address City Name:
HORSHAM
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
19044-1416
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
215-922-2502
Provider Business Mailing Address Fax Number:
215-922-0275

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1250 EASTON RD
Provider Second Line Business Practice Location Address:
SUITE 201 N
Provider Business Practice Location Address City Name:
HORSHAM
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
19044-1416
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-922-2502
Provider Business Practice Location Address Fax Number:
215-922-0275
Provider Enumeration Date:
02/07/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
DUNLEAVY
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
215-922-2502

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  PP481345 , 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: 100929842-0001 , issued by the state of ( PA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 3983017 . This is a "NCPDP" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".