1255633707 NPI number — PAIN MEDICINE CONSULTANTS, INC.

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 1255633707 NPI number — PAIN MEDICINE CONSULTANTS, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PAIN MEDICINE CONSULTANTS, INC.
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:
1255633707
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
100 N WIGET LN
Provider Second Line Business Mailing Address:
SUITE 160
Provider Business Mailing Address City Name:
WALNUT CREEK
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
94598-5988
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
925-287-1256
Provider Business Mailing Address Fax Number:
925-287-0931

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5924 STONERIDGE DR
Provider Second Line Business Practice Location Address:
SUITE 102
Provider Business Practice Location Address City Name:
PLEASANTON
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
94588-2887
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
925-287-1256
Provider Business Practice Location Address Fax Number:
925-287-0913
Provider Enumeration Date:
12/03/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SHINAMAN
Authorized Official First Name:
RICHARD
Authorized Official Middle Name:
CRAIG
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
925-287-1256

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207LP2900X , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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