Provider Demographics
NPI:1407803919
Name:SUN COAST PAIN MANAGEMENT, P.A.
Entity Type:Organization
Organization Name:SUN COAST PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:YEN
Authorized Official - Middle Name:CHOU
Authorized Official - Last Name:CHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:228-818-0053
Mailing Address - Street 1:4 DOCTORS DR
Mailing Address - Street 2:SUITE C
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5721
Mailing Address - Country:US
Mailing Address - Phone:228-818-0053
Mailing Address - Fax:228-818-0110
Practice Address - Street 1:4 DOCTORS DR
Practice Address - Street 2:SUITE C
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5721
Practice Address - Country:US
Practice Address - Phone:228-818-0053
Practice Address - Fax:228-818-0110
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS09015278Medicaid
MS09015278Medicaid