Provider Demographics
NPI:1538290390
Name:PAIN MANAGEMENT AND ANESTHESIA ASSOCIATES
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND ANESTHESIA ASSOCIATES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DOCTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:BOJRAB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-490-2525
Mailing Address - Street 1:10228 DUPONT CIRCLE DR E
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46825-1611
Mailing Address - Country:US
Mailing Address - Phone:260-490-2525
Mailing Address - Fax:260-490-7254
Practice Address - Street 1:10228 DUPONT CIRCLE DR E
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46825-1611
Practice Address - Country:US
Practice Address - Phone:260-490-2525
Practice Address - Fax:260-490-7254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-07
Last Update Date:2013-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN208VP0014X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200096320Medicaid
IN200096320Medicaid