Provider Demographics
NPI:1679562151
Name:PAIN SPECIALISTS A MEDICAL CORP.
Entity Type:Organization
Organization Name:PAIN SPECIALISTS A MEDICAL CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FINANCIAL INSURANCE COORDINATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:
Authorized Official - Last Name:CLEVENGER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:916-440-8001
Mailing Address - Street 1:2825 J ST
Mailing Address - Street 2:SUITE 435
Mailing Address - City:SACRAMENTO
Mailing Address - State:CA
Mailing Address - Zip Code:95816-4300
Mailing Address - Country:US
Mailing Address - Phone:916-440-8001
Mailing Address - Fax:916-440-1030
Practice Address - Street 1:2825 J ST
Practice Address - Street 2:SUITE 435
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95816-4300
Practice Address - Country:US
Practice Address - Phone:916-440-8001
Practice Address - Fax:916-440-1030
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA207LP2900X174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAE07486Medicare UPIN
CAA44498Medicare UPIN
CAA47583Medicare UPIN
CAH86770Medicare UPIN
CAH02989Medicare UPIN
CAH35103Medicare UPIN