Healthcare Provider Details

I. General information

NPI: 1972820017
Provider Name (Legal Business Name): PAIN TREATMENT AND ANESTHESIA MANAGEMENT SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/29/2010
Last Update Date: 05/14/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 HEALTH SERVICES DR STE 401
SEAFORD DE
19973
US

IV. Provider business mailing address

PO BOX 347
SAINT GEORGES DE
19733-0347
US

V. Phone/Fax

Practice location:
  • Phone: 302-536-6094
  • Fax: 302-990-3081
Mailing address:
  • Phone: 302-733-7271
  • Fax: 302-709-2401

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: TAMMY PHILLIPS
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 302-598-9139