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General NPI Number Information
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NPI Number | 1962937441
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Entity Type | Organization
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Legal Business Name | PAIN CARE CENTER LLC
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Dates
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Enumeration Date | 04/21/2017
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Last Update Date | 07/26/2021
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Provider Practice Location Address
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Address Line | 170 ARROWHEAD DR SUITE 2
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City | EVANSTON
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State | WY
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Zip | 82930-9307
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Country | US
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Telephone | 307-212-6270
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Fax | 307-212-6271
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Provider Business Mailing Address
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Address Line | 2620 COMMERCIAL WAY STE 20
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City | ROCK SPRINGS
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State | WY
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Zip | 82901-4705
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Country | US
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Telephone | 307-212-6270
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Fax | 307-212-6271
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Authorized Official
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Title or Position | PHYSICIAN
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Name | JED SHAY
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Credential | M.D.
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Telephone | 307-212-6270
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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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