Provider Demographics
NPI:1225585292
Name:PAIN RELIEF CENTER OF DENNIS
Entity Type:Organization
Organization Name:PAIN RELIEF CENTER OF DENNIS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:SPRAGUE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-394-4847
Mailing Address - Street 1:24 ROUTE 134
Mailing Address - Street 2:SUITE 3
Mailing Address - City:S DENNIS
Mailing Address - State:MA
Mailing Address - Zip Code:02660
Mailing Address - Country:US
Mailing Address - Phone:508-394-4847
Mailing Address - Fax:
Practice Address - Street 1:24 ROUTE 134
Practice Address - Street 2:SUITE 3
Practice Address - City:S DENNIS
Practice Address - State:MA
Practice Address - Zip Code:02660
Practice Address - Country:US
Practice Address - Phone:508-394-4847
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-07
Last Update Date:2016-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2085R0202XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic RadiologyGroup - Multi-Specialty
No2085U0001XAllopathic & Osteopathic PhysiciansRadiologyDiagnostic UltrasoundGroup - Multi-Specialty