MEDICARE: PAIN CENTERS OF AMERICA, INC

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	261Q00000X	Clinic/Center

General Provider Information

NPI Number	:	1881890556
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN CENTERS OF AMERICA, INC

Provider Business Mailing Address
First Line	:	1515 KENSINGTON AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-1436
Country	:	US
Telephone Number	:	716-446-5900
Fax Number	:

Provider Business Practice Location Address
First Line	:	1515 KENSINGTON AVE
Second Line	:
City	:	BUFFALO
State	:	NY
Zip	:	14215-1436
Country	:	US
Telephone Number	:	716-446-5900
Fax Number	:

Authorized Official
Title or Position	:	EVP & COO
Name	:	MS. JONI G. HYRICK
Credential	:
Telephone Number	:	716-446-5900

Provider Enumeration Date	:	06/21/2007
Last Update Date	:	08/22/2020

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