Basic Information
Provider Information
NPI: 1457817413
EntityType: 2
ReplacementNPI:  
OrganizationName: PAIN RELIEF CENTERS PA
LastName:  
FirstName:  
MiddleName:  
NamePrefix:  
NameSuffix:  
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
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Mailing Information
Address1: PO BOX 2065
Address2:  
City: BRYSON CITY
State: NC
PostalCode: 287135065
CountryCode: US
TelephoneNumber: 8284498610
FaxNumber: 8285384441
Practice Location
Address1: 1224 COMMERCE ST SW
Address2:  
City: CONOVER
State: NC
PostalCode: 286138249
CountryCode: US
TelephoneNumber: 8282610467
FaxNumber: 8282670599
Other Information
ProviderEnumerationDate: 02/14/2019
LastUpdateDate: 02/14/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode:  
AuthorizedOfficialLastName: HANSEN
AuthorizedOfficialFirstName: HANS
AuthorizedOfficialMiddleName: CHRISTIAN
AuthorizedOfficialTitleorPosition: MD/OWNER
AuthorizedOfficialTelephone: 8282610467
IsSoleProprietor:  
IsOrganizationSubpart: N
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential: MD
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
332900000X  Y SuppliersNon-Pharmacy Dispensing Site 

No ID Information.


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