Healthcare Provider Details

I. General information

NPI: 1124498746
Provider Name (Legal Business Name): PAIN MEDICINE OF YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2015
Last Update Date: 02/28/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

418 N LOGAN BLVD
BURNHAM PA
17009-1816
US

IV. Provider business mailing address

1497A S. QUEEN STREET
YORK PA
17403
US

V. Phone/Fax

Practice location:
  • Phone: 717-848-3979
  • Fax: 717-668-8967
Mailing address:
  • Phone: 717-848-3979
  • Fax: 717-668-8967

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RODNEY YENTZER
Title or Position: CEO/OWNER
Credential:
Phone: 717-226-1665