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General NPI Number Information
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NPI Number | 1629362579
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Entity Type | Organization
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Legal Business Name | TRACY WIMBUSH PAIN MANAGEMENT INC
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Dates
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Enumeration Date | 06/07/2011
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Last Update Date | 07/06/2011
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Provider Practice Location Address
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Address Line | 1350 OLD FREEPORT RD SUITE 1B
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City | PITTSBURGH
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State | PA
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Zip | 15238-3122
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Country | US
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Telephone | 412-406-7765
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Fax | 412-346-1288
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Provider Business Mailing Address
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Address Line | 1350 OLD FREEPORT RD SUITE 1B
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City | PITTSBURGH
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State | PA
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Zip | 15238-3122
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Country | US
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Telephone | 412-406-7765
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Fax | 412-346-1288
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Authorized Official
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Title or Position | PRESIDENT
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Name | TRACY WIMBUSH
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Credential | M.D.
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Telephone | 412-406-7765
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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