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General NPI Number Information
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NPI Number | 1548214182
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Entity Type | Organization
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Legal Business Name | PAIN CARE INSTITUTE
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Dates
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Enumeration Date | 05/19/2006
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Last Update Date | 12/15/2010
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Provider Practice Location Address
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Address Line | 6200 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-3400
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Country | US
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Telephone | 215-535-3980
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Fax | 215-535-5025
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Provider Business Mailing Address
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Address Line | 6200 FRANKFORD AVE
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City | PHILADELPHIA
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State | PA
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Zip | 19135-3400
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Country | US
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Telephone | 215-535-3980
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Fax | 215-535-5025
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Authorized Official
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Title or Position | OFFICE MANAGER
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Name | MS. TRACEY A EVERHAM
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Credential |
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Telephone | 215-338-1811
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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 | MD045589L
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License Number State | PA
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