Provider Demographics
NPI:1548214182
Name:PAIN CARE INSTITUTE
Entity Type:Organization
Organization Name:PAIN CARE INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:TRACEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:EVERHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-338-1811
Mailing Address - Street 1:6200 FRANKFORD AVE
Mailing Address - Street 2:
Mailing Address - City:PHILADELPHIA
Mailing Address - State:PA
Mailing Address - Zip Code:19135-3400
Mailing Address - Country:US
Mailing Address - Phone:215-535-3980
Mailing Address - Fax:215-535-5025
Practice Address - Street 1:6200 FRANKFORD AVE
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19135-3400
Practice Address - Country:US
Practice Address - Phone:215-535-3980
Practice Address - Fax:215-535-5025
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2010-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD045589L208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0658614000OtherINDEPENDENCE BLUE CROSS
PA50082873OtherCAPITAL BLUE CROSS
PA258129OtherUNISON
PA020429OtherHIGHMARK BLUE SHIELD
PA5541318OtherAETNA
PA258129OtherUNISON
PAF59548Medicare UPIN
PA020429M8WMedicare ID - Type UnspecifiedERIC RATNER PHILADELPHIA
PA020429ZBGQMedicare PIN
PA0658614000OtherINDEPENDENCE BLUE CROSS
PA026578M8WMedicare ID - Type UnspecifiedPAIN CARE INSTITUTE PHILA