Provider Demographics
NPI:1568764959
Name:PAIN MEDICINE CONSULTANTS, INC.
Entity Type:Organization
Organization Name:PAIN MEDICINE CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:CRAIG
Authorized Official - Last Name:SHINAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-287-1256
Mailing Address - Street 1:100 N WIGET LN
Mailing Address - Street 2:SUITE 160
Mailing Address - City:WALNUT CREEK
Mailing Address - State:CA
Mailing Address - Zip Code:94598-5988
Mailing Address - Country:US
Mailing Address - Phone:925-287-1256
Mailing Address - Fax:925-287-0913
Practice Address - Street 1:100 ROWLAND WAY
Practice Address - Street 2:SUITE 200
Practice Address - City:NOVATO
Practice Address - State:CA
Practice Address - Zip Code:94945-5011
Practice Address - Country:US
Practice Address - Phone:925-287-1256
Practice Address - Fax:925-287-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-17
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207LP2900X, 332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6360340001Medicare NSC
CACQ347AMedicare PIN