Basic Information
| Provider Information | |||||||||
| NPI: | 1861637241 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN MANAGEMENT PHYSICIANS, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2201 RIDGEWOOD RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103739631 | ||||||||
| FaxNumber: | 6103756200 | ||||||||
| Practice Location | |||||||||
| Address1: | 2201 RIDGEWOOD RD | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | WYOMISSING | ||||||||
| State: | PA | ||||||||
| PostalCode: | 196101189 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6103739631 | ||||||||
| FaxNumber: | 6103756200 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/12/2008 | ||||||||
| LastUpdateDate: | 12/08/2010 | ||||||||
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| AuthorizedOfficialLastName: | RATNER | ||||||||
| AuthorizedOfficialFirstName: | ERIC | ||||||||
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| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6103739631 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0014X | MD045589L | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 50082873 | 01 | PA | CAPITAL BLUE CROSS | OTHER | 2083563 | 01 | PA | HIGHMARK BLUE SHIELD | OTHER | 258129 | 01 | PA | UNISON | OTHER |