Healthcare Provider Details

I. General information

NPI: 1740796796
Provider Name (Legal Business Name): PAIN MEDICINE OF YORK, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/28/2017
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 HIGH TOWER BLVD STE 200
PITTSBURGH PA
15205
US

IV. Provider business mailing address

507 TIRE HILL RD STE 100
JOHNSTOWN PA
15905-7311
US

V. Phone/Fax

Practice location:
  • Phone: 412-490-0400
  • Fax: 412-490-0300
Mailing address:
  • Phone: 814-467-4055
  • Fax: 814-254-4092

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code207LA0401X
TaxonomyAddiction Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: FLORENTINA MAYKO
Title or Position: CEO
Credential:
Phone: 814-467-4055