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General NPI Number Information
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NPI Number | 1790994838
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Entity Type | Organization
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Legal Business Name | SOUTH PHILADELPHIA PAIN MANAGEMENT
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Dates
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Enumeration Date | 05/22/2007
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Last Update Date | 05/08/2009
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Provider Practice Location Address
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Address Line | 1732 S BROAD ST
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City | PHILADELPHIA
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State | PA
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Zip | 19145-2321
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Country | US
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Telephone | 215-755-7595
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Fax | 215-755-7608
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Provider Business Mailing Address
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Address Line | PO BOX 1006
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City | BENSALEM
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State | PA
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Zip | 19020-5006
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Country | US
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Telephone | 215-755-7595
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Fax | 215-755-7608
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Authorized Official
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Title or Position | BILLING
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Name | MINDY GUSS
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Credential |
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Telephone | 215-750-9600
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208D00000X
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Taxonomy Name | General Practice Physician
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License Number |
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License Number State |
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