Provider Demographics
NPI:1629362579
Name:TRACY WIMBUSH PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:TRACY WIMBUSH PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:WIMBUSH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-406-7765
Mailing Address - Street 1:1350 OLD FREEPORT RD
Mailing Address - Street 2:SUITE 1B
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15238-3122
Mailing Address - Country:US
Mailing Address - Phone:412-406-7765
Mailing Address - Fax:412-346-1288
Practice Address - Street 1:1350 OLD FREEPORT RD
Practice Address - Street 2:SUITE 1B
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15238-3122
Practice Address - Country:US
Practice Address - Phone:412-406-7765
Practice Address - Fax:412-346-1288
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-07
Last Update Date:2011-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty