Healthcare Provider Details

I. General information

NPI: 1083898472
Provider Name (Legal Business Name): PAIN CENTERS OF AMERICA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2007
Last Update Date: 12/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1625 MEDICAL CENTER POINT SUITE 240
COLORADO SPRINGS CO
80907
US

IV. Provider business mailing address

401 CREEKSIDE DRIVE
BUFFALO NY
14228
US

V. Phone/Fax

Practice location:
  • Phone: 719-577-9063
  • Fax:
Mailing address:
  • Phone: 716-691-4123
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JONI G HYRICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 716-691-4123