1336310358 NPI number — TRI STATE PAIN MANAGEMENT SERVICES, P.S.C.

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 1336310358 NPI number — TRI STATE PAIN MANAGEMENT SERVICES, P.S.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TRI STATE PAIN MANAGEMENT SERVICES, P.S.C.
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:
6
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:
1336310358
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/18/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3696
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAWRENCEBURG
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47025-3696
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
812-532-2704
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
606 WILSON CREEK RD
Provider Second Line Business Practice Location Address:
SUITE 120
Provider Business Practice Location Address City Name:
LAWRENCEBURG
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
47025-1095
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
812-532-2704
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/18/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SCHEINER
Authorized Official First Name:
STEVEN
Authorized Official Middle Name:
J
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
812-532-2704

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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