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General NPI Number Information
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NPI Number | 1124100961
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Entity Type | Organization
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Legal Business Name | PAIN AND AGING MANAGEMENT LLC
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Dates
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Enumeration Date | 10/20/2006
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Last Update Date | 05/17/2024
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Provider Practice Location Address
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Address Line | 2400 NORTHPARK DR STE 20
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City | COLUMBUS
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State | IN
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Zip | 47203-4467
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Country | US
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Telephone | 812-376-0700
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Fax | 812-376-8625
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Provider Business Mailing Address
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Address Line | 7951 SHOAL CREEK BLVD STE 300
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City | AUSTIN
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State | TX
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Zip | 78757-7582
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Country | US
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Telephone | 512-584-8404
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Fax | 812-376-8625
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Authorized Official
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Title or Position | CEO
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Name | SANDFORD MATTHEW SCHOCKET
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Credential |
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Telephone | 512-584-8404
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 163W00000X
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Taxonomy Name | Registered Nurse
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 208100000X
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Taxonomy Name | Physical Medicine & Rehabilitation Physician
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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