MEDICARE: US PAIN AND REHABILITATION CENTER, PA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1043836406
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	US PAIN AND REHABILITATION CENTER, PA

Provider Business Mailing Address
First Line	:	1997 SLOAN PL STE 23
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2051
Country	:	US
Telephone Number	:	651-800-4909
Fax Number	:

Provider Business Practice Location Address
First Line	:	1997 SLOAN PL STE 23
Second Line	:
City	:	SAINT PAUL
State	:	MN
Zip	:	55117-2051
Country	:	US
Telephone Number	:	651-800-4909
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. FOUNG LO
Credential	:	MD
Telephone Number	:	651-800-4909

Provider Enumeration Date	:	06/22/2020
Last Update Date	:	06/22/2020

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