Provider Demographics
NPI:1073647590
Name:HEAG PAIN MANAGEMENT CENTER, PA
Entity Type:Organization
Organization Name:HEAG PAIN MANAGEMENT CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KWADWO
Authorized Official - Middle Name:
Authorized Official - Last Name:GYARTENG-DAKWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-220-0107
Mailing Address - Street 1:2800 BATTLEGROUND AVE
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-2704
Mailing Address - Country:US
Mailing Address - Phone:336-282-0132
Mailing Address - Fax:336-282-6962
Practice Address - Street 1:2800 BATTLEGROUND AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408-2704
Practice Address - Country:US
Practice Address - Phone:336-282-0132
Practice Address - Fax:336-282-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-15
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200500050207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCH64710Medicare UPIN