Healthcare Provider Details

I. General information

NPI: 1942540588
Provider Name (Legal Business Name): PAIN SOLUTIONS OF ERIE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/19/2013
Last Update Date: 02/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2409 STATE ST SUITE 1R
ERIE PA
16503-1856
US

IV. Provider business mailing address

2409 STATE ST SUITE 1R
ERIE PA
16503-1856
US

V. Phone/Fax

Practice location:
  • Phone: 814-454-6313
  • Fax: 814-454-6334
Mailing address:
  • Phone: 814-454-6313
  • Fax: 814-454-6334

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberMD034640E
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberMD034640E
License Number StatePA

VIII. Authorized Official

Name: MS. CHARLENE APPLEMAN
Title or Position: DIRECTOR OF BILLING
Credential:
Phone: 603-647-2333