Healthcare Provider Details

I. General information

NPI: 1780951871
Provider Name (Legal Business Name): FIRST PAIN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2011
Last Update Date: 11/17/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11501 W NORTH AVE
WAUWATOSA WI
53226-2127
US

IV. Provider business mailing address

11501 W NORTH AVE
WAUWATOSA WI
53226-2127
US

V. Phone/Fax

Practice location:
  • Phone: 414-737-9070
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MARY VIRGINIA MCCULLOUGH
Title or Position: DIRECTOR
Credential: BSN, RN
Phone: 414-737-9070