Provider Demographics
NPI:1275879017
Name:TAMMY J. PENHOLLOW, DO, PC
Entity Type:Organization
Organization Name:TAMMY J. PENHOLLOW, DO, PC
Other - Org Name:PACIFIC PAIN TREATMENT CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:JOLENE
Authorized Official - Last Name:PENHOLLOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:415-567-1219
Mailing Address - Street 1:2000 VAN NESS AVE
Mailing Address - Street 2:SUITE 402
Mailing Address - City:SAN FRANCISCO
Mailing Address - State:CA
Mailing Address - Zip Code:94109-3023
Mailing Address - Country:US
Mailing Address - Phone:415-567-1219
Mailing Address - Fax:
Practice Address - Street 1:2000 VAN NESS AVE
Practice Address - Street 2:SUITE 402
Practice Address - City:SAN FRANCISCO
Practice Address - State:CA
Practice Address - Zip Code:94109-3023
Practice Address - Country:US
Practice Address - Phone:415-567-1219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-12-26
Last Update Date:2012-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain