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General NPI Number Information
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NPI Number | 1265798599
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT SPECIALISTS MEDICAL GROUP
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Dates
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Enumeration Date | 04/11/2012
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Last Update Date | 10/04/2012
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Provider Practice Location Address
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Address Line | 5000 SAN PALO RD
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City | ATASCADERO
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State | CA
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Zip | 93422-2481
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Country | US
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Telephone | 805-782-8132
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 4659
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City | SAN LUIS OBISPO
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State | CA
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Zip | 93403-4659
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | MANAGING PARTNER
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Name | DR. BORIS PILCH
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Credential | MD
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Telephone | 805-782-8132
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number |
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License Number State |
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