Provider Demographics
NPI:1679506299
Name:PAIN MANAGEMENT EQUIPMENT
Entity Type:Organization
Organization Name:PAIN MANAGEMENT EQUIPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHARLES
Authorized Official - Middle Name:GRANT
Authorized Official - Last Name:MCKINNEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:888-600-9988
Mailing Address - Street 1:23951 STILLWATER LN
Mailing Address - Street 2:
Mailing Address - City:LAGUNA NIGUEL
Mailing Address - State:CA
Mailing Address - Zip Code:92677-1707
Mailing Address - Country:US
Mailing Address - Phone:888-600-9988
Mailing Address - Fax:949-249-1637
Practice Address - Street 1:23951 STILLWATER LN
Practice Address - Street 2:
Practice Address - City:LAGUNA NIGUEL
Practice Address - State:CA
Practice Address - Zip Code:92677-1707
Practice Address - Country:US
Practice Address - Phone:888-600-9988
Practice Address - Fax:949-249-1637
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA0698460001Medicare NSC