Provider Demographics
NPI:1174826440
Name:PIONEER WOODS PAIN SOLUTIONS, INC.
Entity Type:Organization
Organization Name:PIONEER WOODS PAIN SOLUTIONS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:RAE
Authorized Official - Last Name:HENN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:402-420-5303
Mailing Address - Street 1:6800 S 32ND ST
Mailing Address - Street 2:STE. A
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68516-6036
Mailing Address - Country:US
Mailing Address - Phone:402-420-4303
Mailing Address - Fax:402-420-5374
Practice Address - Street 1:4210 PIONEER WOODS DR
Practice Address - Street 2:STE. B
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68506-7561
Practice Address - Country:US
Practice Address - Phone:402-484-0200
Practice Address - Fax:402-484-5677
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-08
Last Update Date:2010-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE25587174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty