Provider Demographics
NPI:1598743981
Name:REHABILITATION MEDICINE & PAIN CENTER PC
Entity Type:Organization
Organization Name:REHABILITATION MEDICINE & PAIN CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:GOODSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:704-664-5766
Mailing Address - Street 1:114 WELTON WAY
Mailing Address - Street 2:SUITE A
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9163
Mailing Address - Country:US
Mailing Address - Phone:704-664-5766
Mailing Address - Fax:704-664-9311
Practice Address - Street 1:114 WELTON WAY
Practice Address - Street 2:SUITE A
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9163
Practice Address - Country:US
Practice Address - Phone:704-664-5766
Practice Address - Fax:704-664-9311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-05
Last Update Date:2007-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC97-013732081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC790243UMedicaid
NC790243UMedicaid
NCG54400Medicare UPIN