MEDICARE: JEFFERSON PAIN AND REHAB CENTER

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	208100000X	Physical Medicine & Rehabilitation Physician	MD037447Y	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier Issuer
1	0076496	OTHER	US HEALTH CARE
2	60216	OTHER	MED PLUS
3	1500227	OTHER	GATEWAY
4	26789	OTHER	HEALTH AMERICA
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	109	OTHER	UPMC FOR YOU

General Provider Information

NPI Number	:	1376526780
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JEFFERSON PAIN AND REHAB CENTER

Provider Business Mailing Address
First Line	:	4735 CLAIRTON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-2115
Country	:	US
Telephone Number	:	412-885-5400
Fax Number	:	412-885-1773

Provider Business Practice Location Address
First Line	:	4735 CLAIRTON BLVD
Second Line	:
City	:	PITTSBURGH
State	:	PA
Zip	:	15236-2115
Country	:	US
Telephone Number	:	412-885-5400
Fax Number	:	412-885-1773

Authorized Official
Title or Position	:	MEDICAL DIR JEFFERSON PAIN & REHAB
Name	:	JOHN KEUN-SANG LEE
Credential	:	MD
Telephone Number	:	412-885-5400

Provider Enumeration Date	:	11/21/2005
Last Update Date	:	08/22/2020

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Directions to “JEFFERSON PAIN AND REHAB CENTER ” Practice Location

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