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General NPI Number Information
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NPI Number | 1538597521
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT & HEALTHCARE OF WEST ALLIS, LLC
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Dates
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Enumeration Date | 10/29/2013
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Last Update Date | 08/04/2015
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Provider Practice Location Address
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Address Line | 6751 W GREENFIELD AVE
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City | WEST ALLIS
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State | WI
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Zip | 53214-4966
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Country | US
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Telephone | 414-777-5066
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Fax | 414-777-5067
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Provider Business Mailing Address
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Address Line | 6751 W GREENFIELD AVE
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City | WEST ALLIS
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State | WI
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Zip | 53214-4966
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Country | US
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Telephone | 414-777-5066
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Fax | 414-777-5067
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Authorized Official
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Title or Position | OWNER, CEO
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Name | DR. BARBARA J JOHNSON FARMER
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Credential | RN, ARNP, FNP, PHD
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Telephone | 414-777-5066
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | 2798-33
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License Number State | WI
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