Provider Demographics
NPI:1497144828
Name:THUNDER PAIN MANAGEMENT, P.C.
Entity Type:Organization
Organization Name:THUNDER PAIN MANAGEMENT, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KENNETH
Authorized Official - Middle Name:TODD
Authorized Official - Last Name:THUNDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:775-336-1256
Mailing Address - Street 1:6548 S MCCARRAN BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89509-6150
Mailing Address - Country:US
Mailing Address - Phone:775-336-1256
Mailing Address - Fax:775-336-6410
Practice Address - Street 1:6548 S MCCARRAN BLVD STE A
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89509-6150
Practice Address - Country:US
Practice Address - Phone:775-336-1256
Practice Address - Fax:775-336-6410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-22
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV8854207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty