Basic Information
| Provider Information | |||||||||
| NPI: | 1649766742 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | SMR PAIN MANAGEMENT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 213 REECEVILLE RD STE 14 | ||||||||
| Address2: | |||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193201585 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153381811 | ||||||||
| FaxNumber: | 2153383606 | ||||||||
| Practice Location | |||||||||
| Address1: | 213 REECEVILLE RD STE 10 | ||||||||
| Address2: | |||||||||
| City: | COATESVILLE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 193201532 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2153381811 | ||||||||
| FaxNumber: | 2153383606 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/02/2018 | ||||||||
| LastUpdateDate: | 09/15/2021 | ||||||||
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| AuthorizedOfficialLastName: | LINCOW | ||||||||
| AuthorizedOfficialFirstName: | RONALD | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 2153381811 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | DO | ||||||||
| NPICertificationDate: | 09/15/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine | 2081P2900X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Physical Medicine & Rehabilitation | Pain Medicine |
No ID Information.