Provider Demographics
NPI:1417614116
Name:PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Other - Org Name:ADVANCED ANALYTICAL DIAGNOSTIX
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MAHENDRA
Authorized Official - Middle Name:R
Authorized Official - Last Name:SANAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-573-1207
Mailing Address - Street 1:1101 PROFESSIONAL BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-8018
Mailing Address - Country:US
Mailing Address - Phone:812-477-7246
Mailing Address - Fax:812-477-7240
Practice Address - Street 1:1101 PROFESSIONAL BLVD STE 215
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8016
Practice Address - Country:US
Practice Address - Phone:812-477-7246
Practice Address - Fax:812-477-7240
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN MANAGEMENT CENTERS OF AMERICA, PSC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-11-17
Last Update Date:2022-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN300023007Medicaid