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NPI Code Detail

MEDICARE: WEST SHORE PAIN AND SPINE INSTITUTE, LLC

MEDICARE: WEST SHORE PAIN AND SPINE INSTITUTE, 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
1261QA1903XAmbulatory Surgical Clinic/Center

General Provider Information

NPI Number : 1851845986
Entity Type Code : Organization
Provider Name (Legal Business Name) : WEST SHORE PAIN AND SPINE INSTITUTE, LLC
Provider Business Mailing Address
First Line : 825 SIR THOMAS CT
Second Line :
City : HARRISBURG
State : PA
Zip : 17109-4839
Country : US
Telephone Number : 717-901-5008
Fax Number :
Provider Business Practice Location Address
First Line : 5124 E TRINDLE RD
Second Line :
City : MECHANICSBURG
State : PA
Zip : 17050-3688
Country : US
Telephone Number : 717-652-8670
Fax Number : 717-920-3261
Authorized Official
Title or Position : MEDICAL DIRECTOR
Name : MALIK MOMIN
Credential : M.D.
Telephone Number : 717-901-5008
Provider Enumeration Date : 08/05/2016
Last Update Date : 08/05/2016

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Directions to “WEST SHORE PAIN AND SPINE INSTITUTE, LLC ” Practice Location

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