Provider Demographics
NPI:1639596794
Name:MEDICAL PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:MEDICAL PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAFT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:717-652-5550
Mailing Address - Street 1:915 N MOUNTAIN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:HARRISBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17112-1793
Mailing Address - Country:US
Mailing Address - Phone:717-652-5550
Mailing Address - Fax:717-652-2488
Practice Address - Street 1:915 N MOUNTAIN RD
Practice Address - Street 2:SUITE C
Practice Address - City:HARRISBURG
Practice Address - State:PA
Practice Address - Zip Code:17112-1793
Practice Address - Country:US
Practice Address - Phone:717-652-5550
Practice Address - Fax:717-652-2488
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-26
Last Update Date:2014-03-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty