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General NPI Number Information
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NPI Number | 1215106323
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Entity Type | Organization
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Legal Business Name | TRI-STATE PAIN INSTITUTE LLC
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Dates
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Enumeration Date | 02/22/2008
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Last Update Date | 09/11/2020
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Provider Practice Location Address
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Address Line | 2374 VILLAGE COMMON DR SUITE 100
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City | ERIE
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State | PA
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Zip | 16506-7201
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Country | US
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Telephone | 814-833-7246
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Fax | 814-833-1147
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Provider Business Mailing Address
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Address Line | 2374 VILLAGE COMMON DR SUITE 100
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City | ERIE
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State | PA
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Zip | 16506-7201
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Country | US
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Telephone | 814-833-7246
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Fax | 814-833-1147
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Authorized Official
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Title or Position | SUPERVISOR
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Name | JOSEPH A THOMAS
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Credential |
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Telephone | 814-833-1147
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2081P2900X
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Taxonomy Name | Pain Medicine (Physical Medicine & Rehabilitation) Physician
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License Number | MD045797L
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License Number State | PA
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | MD045797L
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License Number State | PA
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