Provider Demographics
NPI:1245238492
Name:ADVANCED PAIN MEDICINE, PSC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICINE, PSC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SAROJ
Authorized Official - Middle Name:B
Authorized Official - Last Name:DUBAL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:859-271-3114
Mailing Address - Street 1:PO BOX 23955
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40523-3955
Mailing Address - Country:US
Mailing Address - Phone:859-271-3114
Mailing Address - Fax:859-271-0220
Practice Address - Street 1:101 PROSPEROUS PL
Practice Address - Street 2:SUITE 300
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1882
Practice Address - Country:US
Practice Address - Phone:859-271-3114
Practice Address - Fax:859-271-0220
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-12
Last Update Date:2014-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Multi-Specialty
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYC15401OtherBLUEGRASS FAMILY HEALTH
KY1168975OtherCHA HEALTH PIN
KY65906067Medicaid
KY050076771OtherRAILROAD MEDICARE
KY000000108103OtherANTHEM B/C & B/S PIN
KY050076771OtherRAILROAD MEDICARE