Provider Demographics
NPI:1679582738
Name:D&R PAIN MANAGEMENT INC.
Entity Type:Organization
Organization Name:D&R PAIN MANAGEMENT INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:LIST
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-528-1088
Mailing Address - Street 1:PO BOX 1088
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0088
Mailing Address - Country:US
Mailing Address - Phone:724-528-1088
Mailing Address - Fax:
Practice Address - Street 1:239 EDGEWOOD DR. EXT.
Practice Address - Street 2:
Practice Address - City:TRANSFER
Practice Address - State:PA
Practice Address - Zip Code:16154
Practice Address - Country:US
Practice Address - Phone:724-646-0400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-07
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1012084910001Medicaid
PA082761Medicare PIN