Provider Demographics
NPI:1396043071
Name:SOUTHBRIDGE INTERVENTIONAL PAIN,INC
Entity Type:Organization
Organization Name:SOUTHBRIDGE INTERVENTIONAL PAIN,INC
Other - Org Name:SOUTHBRIDGE INTERVENTIONAL PAIN ,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ASHRAF
Authorized Official - Middle Name:
Authorized Official - Last Name:FARID
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:508-333-0449
Mailing Address - Street 1:PO BOX 426
Mailing Address - Street 2:
Mailing Address - City:SOUTHBRIDGE
Mailing Address - State:MA
Mailing Address - Zip Code:01550-0426
Mailing Address - Country:US
Mailing Address - Phone:508-347-9111
Mailing Address - Fax:
Practice Address - Street 1:48 MAIN ST STE 6
Practice Address - Street 2:
Practice Address - City:STURBRIDGE
Practice Address - State:MA
Practice Address - Zip Code:01566-1284
Practice Address - Country:US
Practice Address - Phone:508-347-9111
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-04
Last Update Date:2023-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA212790207LP2900X
208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
87193Medicare UPIN