MEDICARE: GREATER PHILADELPHIA PAIN MANAGEMENT CENTER P.C.

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	111N00000X	Chiropractor	DC007401L	PA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0081342000	OTHER	PA	KEYSTONE
2	416307	OTHER	PA	HIGHMARK
3	3341682	OTHER	PA	AETNA
4	CIGNA	OTHER	PA	1046273

General Provider Information

NPI Number	:	1821390923
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GREATER PHILADELPHIA PAIN MANAGEMENT CENTER P.C.

Provider Business Mailing Address
First Line	:	104 BAILEY DR
Second Line	:
City	:	NORTH WALES
State	:	PA
Zip	:	19454-4526
Country	:	US
Telephone Number	:	215-962-6031
Fax Number	:	215-957-5401

Provider Business Practice Location Address
First Line	:	2612 RHAWN ST
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19152-3415
Country	:	US
Telephone Number	:	215-338-8555
Fax Number	:	215-338-8031

Authorized Official
Title or Position	:	PHYSICIAN
Name	:	GENE LEVINSTEIN
Credential	:	MD
Telephone Number	:	215-957-5400

Provider Enumeration Date	:	11/22/2010
Last Update Date	:	05/12/2011

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