Healthcare Provider Details

I. General information

NPI: 1225130131
Provider Name (Legal Business Name): PROFESSIONAL PAIN MANAGMENT ASSOCIATES, PC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1098 W BALTIMORE PIKE SUITE 3306
MEDIA PA
19063-5139
US

IV. Provider business mailing address

804 SCOTT NIXON MEMORIAL DR
AUGUSTA GA
30907-2464
US

V. Phone/Fax

Practice location:
  • Phone: 215-925-0986
  • Fax: 215-829-0446
Mailing address:
  • Phone: 800-394-4445
  • Fax: 706-650-1034

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JASON C CWIK
Title or Position: PRESIDENT
Credential: M.D.
Phone: 215-829-3867