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General NPI Number Information
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NPI Number | 1366498115
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Entity Type | Organization
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Legal Business Name | VALLEY PAIN CENTER, L.L.C.
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Dates
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Enumeration Date | 05/25/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1800 BYBERRY RD SUITE 1101
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-3518
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Country | US
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Telephone | 215-947-7992
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Fax | 215-947-7969
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Provider Business Mailing Address
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Address Line | 1800 BYBERRY RD SUITE 1101
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City | HUNTINGDON VALLEY
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State | PA
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Zip | 19006-3518
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Country | US
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Telephone | 215-947-7992
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Fax | 215-947-7969
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Authorized Official
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Title or Position | ADMINISTRATIVE DIRECTOR
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Name | MARIE HENNIGAR
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Credential |
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Telephone | 215-947-7992
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA1903X
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Taxonomy Name | Ambulatory Surgical Clinic/Center
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License Number | 17161501
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License Number State | PA
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