Provider Demographics
NPI:1417315235
Name:MEDICAL ADVANCED PAIN SPECIALISTS, PA
Entity Type:Organization
Organization Name:MEDICAL ADVANCED PAIN SPECIALISTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:SCHULTZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:763-537-6000
Mailing Address - Street 1:4131 W LOOMIS RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53221-2057
Mailing Address - Country:US
Mailing Address - Phone:414-325-7246
Mailing Address - Fax:
Practice Address - Street 1:3000 HUNDERTMARK RD
Practice Address - Street 2:SUITE 250
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-1150
Practice Address - Country:US
Practice Address - Phone:763-537-6000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-08
Last Update Date:2016-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies