Healthcare Provider Details

I. General information

NPI: 1033464789
Provider Name (Legal Business Name): INTEGRATIVE PAIN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2012
Last Update Date: 02/04/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1572 MCDANIEL DR
WEST CHESTER PA
19380-6673
US

IV. Provider business mailing address

1572 MCDANIEL DR
WEST CHESTER PA
19380-6673
US

V. Phone/Fax

Practice location:
  • Phone: 610-732-4251
  • Fax: 855-203-5123
Mailing address:
  • Phone: 610-732-4251
  • Fax: 855-203-5123

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: DR. PANKAJ GARG
Title or Position: OWNER
Credential: MD
Phone: 610-732-4251