Provider Demographics
NPI:1568687424
Name:NEURO-PAIN MEDICAL CENTER INC
Entity Type:Organization
Organization Name:NEURO-PAIN MEDICAL CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:PERMINDER
Authorized Official - Middle Name:J
Authorized Official - Last Name:BHATIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:559-437-9700
Mailing Address - Street 1:736 E BULLARD AVE
Mailing Address - Street 2:101
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93710-5473
Mailing Address - Country:US
Mailing Address - Phone:559-437-9700
Mailing Address - Fax:559-437-9799
Practice Address - Street 1:736 E BULLARD AVE
Practice Address - Street 2:101
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-5473
Practice Address - Country:US
Practice Address - Phone:559-437-9700
Practice Address - Fax:559-437-9799
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-16
Last Update Date:2013-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA00A617970Medicaid
CAZZZ22759ZMedicare PIN
CA00A617970Medicaid