Provider Demographics
NPI:1083631410
Name:ALTOONA PAIN MANAGEMENT ASSOCIATES, PC
Entity Type:Organization
Organization Name:ALTOONA PAIN MANAGEMENT ASSOCIATES, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:FRED
Authorized Official - Middle Name:K
Authorized Official - Last Name:KHALOUF
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:814-941-3272
Mailing Address - Street 1:PO BOX 297
Mailing Address - Street 2:
Mailing Address - City:HOLLIDAYSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:16648-0297
Mailing Address - Country:US
Mailing Address - Phone:814-941-3272
Mailing Address - Fax:
Practice Address - Street 1:2005 VALLEY VIEW BLVD
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602-4548
Practice Address - Country:US
Practice Address - Phone:814-941-3272
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS004841L208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PAC28416Medicare UPIN