Healthcare Provider Details

I. General information

NPI: 1124100961
Provider Name (Legal Business Name): PAIN AND AGING MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 05/17/2024
Certification Date: 05/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 NORTHPARK DR STE 20
COLUMBUS IN
47203-4467
US

IV. Provider business mailing address

7951 SHOAL CREEK BLVD STE 300
AUSTIN TX
78757-7582
US

V. Phone/Fax

Practice location:
  • Phone: 812-376-0700
  • Fax: 812-376-8625
Mailing address:
  • Phone: 512-584-8404
  • Fax: 812-376-8625

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name: SANDFORD MATTHEW SCHOCKET
Title or Position: CEO
Credential:
Phone: 512-584-8404