Provider Demographics
NPI:1033540133
Name:FLAGSHIP PAIN MANAGEMENT AND REHABILITATION LLC
Entity Type:Organization
Organization Name:FLAGSHIP PAIN MANAGEMENT AND REHABILITATION LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:FREAS
Authorized Official - Suffix:JR
Authorized Official - Credentials:SLP
Authorized Official - Phone:301-722-3215
Mailing Address - Street 1:157 BALTIMORE ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:CUMBERLAND
Mailing Address - State:MD
Mailing Address - Zip Code:21502-2472
Mailing Address - Country:US
Mailing Address - Phone:301-722-3215
Mailing Address - Fax:301-722-1450
Practice Address - Street 1:157 BALTIMORE ST
Practice Address - Street 2:SUITE 301
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-2472
Practice Address - Country:US
Practice Address - Phone:301-722-3215
Practice Address - Fax:301-722-1450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-29
Last Update Date:2013-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QR0400XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD000000OtherCOMMERCIAL