Healthcare Provider Details

I. General information

NPI: 1396043071
Provider Name (Legal Business Name): SOUTHBRIDGE INTERVENTIONAL PAIN,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2011
Last Update Date: 05/09/2023
Certification Date: 05/09/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

48 MAIN ST STE 6
STURBRIDGE MA
01566-1284
US

IV. Provider business mailing address

PO BOX 426
SOUTHBRIDGE MA
01550-0426
US

V. Phone/Fax

Practice location:
  • Phone: 508-347-9111
  • Fax:
Mailing address:
  • Phone: 508-347-9111
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number212790
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. ASHRAF FARID
Title or Position: OWNER
Credential: MD
Phone: 508-333-0449