Healthcare Provider Details

I. General information

NPI: 1235773789
Provider Name (Legal Business Name): PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2019
Last Update Date: 04/30/2022
Certification Date: 04/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6400 DUTCHMANS PKWY STE 60
LOUISVILLE KY
40205-3341
US

IV. Provider business mailing address

1120 PROFESSIONAL BLVD
EVANSVILLE IN
47714-8000
US

V. Phone/Fax

Practice location:
  • Phone: 502-780-6880
  • Fax: 502-780-6911
Mailing address:
  • Phone: 128-479-9500
  • Fax: 812-437-0037

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MAHENDRA R. SANAPATI
Title or Position: PRESIDENT
Credential: MD
Phone: 812-477-7246