Healthcare Provider Details

I. General information

NPI: 1104852375
Provider Name (Legal Business Name): FRENCH CREEK PAIN MANAGEMENT,PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1034 GROVE ST
MEADVILLE PA
16335-2945
US

IV. Provider business mailing address

463 PINE ST
MEADVILLE PA
16335-2963
US

V. Phone/Fax

Practice location:
  • Phone: 804-333-5736
  • Fax: 814-333-5819
Mailing address:
  • Phone: 814-333-5872
  • Fax: 814-333-5832

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD027700E
License Number StatePA

VIII. Authorized Official

Name: DR. ROBERT R CONCILUS
Title or Position: OWNER
Credential: M.D.
Phone: 814-333-5872