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NPI Code Detail

MEDICARE: PAIN MANAGEMENT CENTERS OF AMERICA, PSC

MEDICARE: PAIN MANAGEMENT CENTERS OF AMERICA, PSC
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
12084P0800XPsychiatry Physician
2332B00000XDurable Medical Equipment & Medical Supplies
3363LF0000XFamily Nurse Practitioner
4208VP0014XInterventional Pain Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1407323918
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Provider Business Mailing Address
First Line : 1101 PROFESSIONAL BLVD STE 100
Second Line :
City : EVANSVILLE
State : IN
Zip : 47714-8018
Country : US
Telephone Number : 812-477-7246
Fax Number : 812-477-7240
Provider Business Practice Location Address
First Line : 67 LAKEVIEW DR
Second Line :
City : PADUCAH
State : KY
Zip : 42001-5619
Country : US
Telephone Number : 812-477-7246
Fax Number : 812-477-7240
Authorized Official
Title or Position : PRESIDENT
Name : MAHENDRA R. SANAPATI
Credential : MD
Telephone Number : 812-477-7246
Provider Enumeration Date : 11/01/2018
Last Update Date : 04/30/2022

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