Healthcare Provider Details

I. General information

NPI: 1568764959
Provider Name (Legal Business Name): PAIN MEDICINE CONSULTANTS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2010
Last Update Date: 12/03/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 ROWLAND WAY SUITE 200
NOVATO CA
94945-5011
US

IV. Provider business mailing address

100 N WIGET LN SUITE 160
WALNUT CREEK CA
94598-5988
US

V. Phone/Fax

Practice location:
  • Phone: 925-287-1256
  • Fax: 925-287-0913
Mailing address:
  • Phone: 925-287-1256
  • Fax: 925-287-0913

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number StateCA

VIII. Authorized Official

Name: DR. RICHARD CRAIG SHINAMAN
Title or Position: PARTNER
Credential: M.D.
Phone: 925-287-1256