Provider Demographics
NPI:1528607140
Name:PREMIER SPINE & PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:PREMIER SPINE & PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ARUN
Authorized Official - Middle Name:M
Authorized Official - Last Name:KANDRA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-438-5071
Mailing Address - Street 1:3735 EASTON NAZARETH HWY STE 203
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:PA
Mailing Address - Zip Code:18045-8346
Mailing Address - Country:US
Mailing Address - Phone:610-438-5071
Mailing Address - Fax:
Practice Address - Street 1:3735 EASTON NAZARETH HWY STE 203
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:PA
Practice Address - Zip Code:18045-8346
Practice Address - Country:US
Practice Address - Phone:610-438-5071
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-30
Last Update Date:2019-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty