MEDICARE: ADVANCED PAIN SOLUTIONS, LLC

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	207Q00000X	Family Medicine Physician	042785	CT
2	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician	041516	CT

General Provider Information

NPI Number	:	1083904163
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN SOLUTIONS, LLC

Provider Business Mailing Address
First Line	:	112 PORTLAND AVE
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-3119
Country	:	US
Telephone Number	:	203-544-9090
Fax Number	:	203-544-7300

Provider Business Practice Location Address
First Line	:	112 PORTLAND AVE
Second Line	:
City	:	REDDING
State	:	CT
Zip	:	06896-3119
Country	:	US
Telephone Number	:	203-544-9090
Fax Number	:	203-544-7300

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	MR. PERRY M PERRETZ
Credential	:	D.O.
Telephone Number	:	203-544-9090

Provider Enumeration Date	:	04/11/2011
Last Update Date	:	04/11/2011

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