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General NPI Number Information
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NPI Number | 1689666315
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Entity Type | Organization
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Legal Business Name | PAIN CARE PROFESSIONALS, INC.
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Dates
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Enumeration Date | 08/18/2005
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | HAHNEMANN UNIVERSITY HOSPITAL PAIN CLINIC BROAD & VINE ST., 4TH FLOOR SOUTH TOWER
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City | PHILADELPHIA
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State | PA
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Zip | 19096
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Country | US
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Telephone | 610-795-7375
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Fax | 610-795-7376
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Provider Business Mailing Address
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Address Line | PO BOX 237
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City | WYNNEWOOD
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State | PA
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Zip | 19096-0237
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Country | US
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Telephone | 610-642-3527
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Fax | 610-795-7376
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. WES PROKOP
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Credential | M.D.
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Telephone | 610-642-3527
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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