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General NPI Number Information
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NPI Number | 1831319870
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Entity Type | Organization
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Legal Business Name | OSTEOPATHIC PAIN MANAGEMENT SERVICES LLC
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Dates
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Enumeration Date | 05/01/2007
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Last Update Date | 12/17/2019
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Provider Practice Location Address
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Address Line | 153 OAKDALE RD
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1007
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Country | US
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Telephone | 607-748-9001
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Fax | 607-748-8546
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Provider Business Mailing Address
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Address Line | 153 OAKDALE RD
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City | JOHNSON CITY
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State | NY
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Zip | 13790-1007
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Country | US
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Telephone | 607-748-9001
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Fax | 607-748-8546
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Authorized Official
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Title or Position | PHYSCIAN OWNER
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Name | DR. KEVIN L HASTINGS JR.
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Credential | DO
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Telephone | 607-748-9001
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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 | 200637
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License Number State | NY
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