Provider Demographics
NPI:1033354329
Name:PAIN CENTERS OF AMERICA
Entity Type:Organization
Organization Name:PAIN CENTERS OF AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-691-2309
Mailing Address - Street 1:401 CREEKSIDE DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:NY
Mailing Address - Zip Code:14228-2040
Mailing Address - Country:US
Mailing Address - Phone:716-691-2311
Mailing Address - Fax:716-691-9579
Practice Address - Street 1:10050 W 41ST AVE
Practice Address - Street 2:
Practice Address - City:WHEAT RIDGE
Practice Address - State:CO
Practice Address - Zip Code:80033-4157
Practice Address - Country:US
Practice Address - Phone:303-432-8777
Practice Address - Fax:303-432-8778
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-16
Last Update Date:2009-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO19757367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty