Provider Demographics
NPI:1083691331
Name:PAINCARE MEDICAL GROUP, INC.
Entity Type:Organization
Organization Name:PAINCARE MEDICAL GROUP, INC.
Other - Org Name:PAINCARE SURGICENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:LARRY
Authorized Official - Middle Name:C
Authorized Official - Last Name:HO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:949-457-9900
Mailing Address - Street 1:15701 ROCKFIELD BLVD
Mailing Address - Street 2:
Mailing Address - City:IRVINE
Mailing Address - State:CA
Mailing Address - Zip Code:92618-2801
Mailing Address - Country:US
Mailing Address - Phone:949-457-9900
Mailing Address - Fax:949-457-9922
Practice Address - Street 1:15701 ROCKFIELD BLVD
Practice Address - Street 2:
Practice Address - City:IRVINE
Practice Address - State:CA
Practice Address - Zip Code:92618-2801
Practice Address - Country:US
Practice Address - Phone:949-457-9900
Practice Address - Fax:949-457-9922
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAS051429Medicare ID - Type Unspecified