MEDICARE: PAIN 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	261QP3300X	Pain Clinic/Center	G74208	CA

Other Identifiers

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

General Provider Information

NPI Number	:	1417210683
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN CENTER

Provider Business Mailing Address
First Line	:	6548 ASHBURY CIR
Second Line	:
City	:	HUNTINGTON BEACH
State	:	CA
Zip	:	92648-6635
Country	:	US
Telephone Number	:	714-991-7246
Fax Number	:	714-908-7793

Provider Business Practice Location Address
First Line	:	817 W 17TH ST
Second Line	:
City	:	SANTA ANA
State	:	CA
Zip	:	92706-3624
Country	:	US
Telephone Number	:	714-969-8287
Fax Number	:	714-908-7793

Authorized Official
Title or Position	:	OWNER
Name	:	TIMOTHY E LYNCH
Credential	:	MD
Telephone Number	:	714-991-7346

Provider Enumeration Date	:	06/21/2012
Last Update Date	:	06/21/2012

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Directions to “PAIN CENTER ” Practice Location

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