Provider Demographics
NPI:1508934373
Name:CENTERS FOR PAIN SOLUTIONS,LLC
Entity Type:Organization
Organization Name:CENTERS FOR PAIN SOLUTIONS,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXEC VP CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:M
Authorized Official - Last Name:JANKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:603-577-3003
Mailing Address - Street 1:280 MAIN STREET
Mailing Address - Street 2:SUITE 420
Mailing Address - City:NASHUA
Mailing Address - State:NH
Mailing Address - Zip Code:03060
Mailing Address - Country:US
Mailing Address - Phone:603-577-3003
Mailing Address - Fax:603-577-3331
Practice Address - Street 1:280 MAIN STREET
Practice Address - Street 2:SUITE 420
Practice Address - City:NASHUA
Practice Address - State:NH
Practice Address - Zip Code:03060
Practice Address - Country:US
Practice Address - Phone:603-577-3003
Practice Address - Fax:603-577-3331
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-01
Last Update Date:2008-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH02841261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
NH30621691Medicaid
NHCE301020Medicare ID - Type Unspecified