Provider Demographics
NPI:1235773789
Name:PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-477-7246
Mailing Address - Street 1:1120 PROFESSIONAL BLVD
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8000
Mailing Address - Country:US
Mailing Address - Phone:128-479-9500
Mailing Address - Fax:812-437-0037
Practice Address - Street 1:6400 DUTCHMANS PKWY STE 60
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205-3341
Practice Address - Country:US
Practice Address - Phone:502-780-6880
Practice Address - Fax:502-780-6911
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-28
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN710053770Medicaid
KY710053770Medicaid