Healthcare Provider Details

I. General information

NPI: 1689666315
Provider Name (Legal Business Name): PAIN CARE PROFESSIONALS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2005
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

HAHNEMANN UNIVERSITY HOSPITAL PAIN CLINIC BROAD & VINE ST., 4TH FLOOR SOUTH TOWER
PHILADELPHIA PA
19096
US

IV. Provider business mailing address

PO BOX 237
WYNNEWOOD PA
19096-0237
US

V. Phone/Fax

Practice location:
  • Phone: 610-795-7375
  • Fax: 610-795-7376
Mailing address:
  • Phone: 610-642-3527
  • Fax: 610-795-7376

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. WES PROKOP
Title or Position: PRESIDENT
Credential: M.D.
Phone: 610-642-3527