Healthcare Provider Details

I. General information

NPI: 1295055648
Provider Name (Legal Business Name): PAIN BE-GONE ANESTHESIA SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/08/2010
Last Update Date: 08/18/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1001 12TH ST N
HUMBOLDT IA
50548
US

IV. Provider business mailing address

PO BOX 265
HUMBOLDT IA
50548-0265
US

V. Phone/Fax

Practice location:
  • Phone: 515-604-6618
  • Fax: 515-604-6627
Mailing address:
  • Phone: 515-604-6618
  • Fax: 515-604-6627

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number367500000X
License Number StateIA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: MR. GREGORY ALLEN PEKKALA
Title or Position: PAIN SPECIALIST
Credential: CRNA
Phone: 515-604-6618