Healthcare Provider Details

I. General information

NPI: 1104967157
Provider Name (Legal Business Name): US CARE PAIN CLINIC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2007
Last Update Date: 09/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

955 CHALKSTONE AVE 2ND FLOOR
PROVIDENCE RI
02908-4220
US

IV. Provider business mailing address

12 KIRKBRAE DR
LINCOLN RI
02865-1008
US

V. Phone/Fax

Practice location:
  • Phone: 401-228-7585
  • Fax:
Mailing address:
  • Phone: 401-228-7585
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberMD10308
License Number StateRI

VIII. Authorized Official

Name: HAFEEZ URRAHMAN KHAN
Title or Position: PRESIDENT
Credential: MD
Phone: 401-228-7585