Provider Demographics
NPI:1598736183
Name:PAIN MANAGEMENT & ANESTHESIOLOGY ASSOCIATES LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT & ANESTHESIOLOGY ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:DAVID
Authorized Official - Last Name:HORD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-377-1647
Mailing Address - Street 1:PO BOX 5615
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93755-5615
Mailing Address - Country:US
Mailing Address - Phone:800-436-1018
Mailing Address - Fax:559-354-4235
Practice Address - Street 1:2825 RANDOLPH RD
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28211-1075
Practice Address - Country:US
Practice Address - Phone:704-377-1647
Practice Address - Fax:559-354-4235
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-31
Last Update Date:2010-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC207L00000X, 207LP2900X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89014FKMedicaid
NC0219COtherBLUE CROSS BLUE SHIELD
NC8000323Medicaid
NCCK4257OtherRAILROAD MEDICARE
NC0219COtherBLUE CROSS BLUE SHIELD
NC2329194Medicare ID - Type UnspecifiedPHYSICIANS M/CARE NO