Healthcare Provider Details

I. General information

NPI: 1508934373
Provider Name (Legal Business Name): CENTERS FOR PAIN SOLUTIONS,LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2006
Last Update Date: 12/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

280 MAIN STREET SUITE 420
NASHUA NH
03060
US

IV. Provider business mailing address

280 MAIN STREET SUITE 420
NASHUA NH
03060
US

V. Phone/Fax

Practice location:
  • Phone: 603-577-3003
  • Fax: 603-577-3331
Mailing address:
  • Phone: 603-577-3003
  • Fax: 603-577-3331

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number02841
License Number StateNH

VIII. Authorized Official

Name: GARY M JANKO
Title or Position: EXEC VP CHIEF OPERATING OFFICER
Credential:
Phone: 603-577-3003