Provider Demographics
NPI:1003026253
Name:PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT PC
Other - Org Name:FREMONT REGIONAL ANESTHESIA SPECIALTY SERVICES P.C.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:KENT
Authorized Official - Last Name:PERRY
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:402-492-8544
Mailing Address - Street 1:13811 CHARLES ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-3883
Mailing Address - Country:US
Mailing Address - Phone:402-492-8544
Mailing Address - Fax:402-391-8979
Practice Address - Street 1:8031 W CENTER RD
Practice Address - Street 2:SUITE 226
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68124-3134
Practice Address - Country:US
Practice Address - Phone:402-391-8978
Practice Address - Fax:402-391-8979
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2012-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE100507367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty