1265488308 NPI number — CLINICAL PAIN MANAGEMENT ASSOCIATES, 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 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".




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