Healthcare Provider Details

I. General information

NPI: 1346525136
Provider Name (Legal Business Name): PREFERRED PAIN MANAGEMENT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2011
Last Update Date: 10/12/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

153 W LAKE MEAD PKWY
HENDERSON NV
89015-7044
US

IV. Provider business mailing address

153 W LAKE MEAD PKWY
HENDERSON NV
89015-7044
US

V. Phone/Fax

Practice location:
  • Phone: 855-544-7246
  • Fax:
Mailing address:
  • Phone: 855-544-7246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: MR. JACK WILLIAM HANEMAN
Title or Position: CEO
Credential:
Phone: 916-784-2200