Healthcare Provider Details

I. General information

NPI: 1235426065
Provider Name (Legal Business Name): SUMMIT PAIN MANAGEMENT INSTITUTE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2011
Last Update Date: 06/30/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1121 MAIDU DR
AUBURN CA
95603-5808
US

IV. Provider business mailing address

1121 MAIDU DR
AUBURN CA
95603-5808
US

V. Phone/Fax

Practice location:
  • Phone: 530-888-1118
  • Fax: 530-888-8832
Mailing address:
  • Phone: 530-888-1118
  • Fax: 530-888-8832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License Number
License Number State

VIII. Authorized Official

Name: KARANJIT BASRAI
Title or Position: OWNER
Credential: M.D.
Phone: 530-888-1118