1205880002 NPI number — 3B PAIN MANAGEMENT CENTER PC

Table of content: (NPI 1205880002)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1205880002 NPI number — 3B PAIN MANAGEMENT CENTER PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
3B 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:
1205880002
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/09/2020
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:
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:
600 LOUIS DRIVE SUITE 202
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WARMINSTER
Provider Business Practice Location Address State Name:
PA
Provider Business Practice Location Address Postal Code:
18974
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
215-957-5400
Provider Business Practice Location Address Fax Number:
215-957-5401
Provider Enumeration Date:
05/19/2006

Additional Information

Authorized Official

Authorized Official Last Name:
EPSTEIN
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
215-957-5400

Provider Taxonomy Codes

  • Taxonomy code: 111N00000X , with the licence number:  DC8629 , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 2081P2900X , with the licence number: MD067744L , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1041907 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1539943 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3425185000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3546777 . This is a "AETNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2225058000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 7135608 . This is a "AETNA PPO/POS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1231975 . This is a "CIGNA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2011106 . This is a "BCBS" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2225058000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3425185000 . This is a "KEYSTONE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: DD8623 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 2225058000 . This is a "PERSONAL CHOICE" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 3245185000 . This is a "AMERIHEALTH" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".




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