Provider Demographics
NPI:1689199853
Name:PAIN-EASE-BRACES LLC
Entity Type:Organization
Organization Name:PAIN-EASE-BRACES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAVORAH
Authorized Official - Middle Name:
Authorized Official - Last Name:PATTERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:757-610-3342
Mailing Address - Street 1:5636 WHITESVILLE RD STE D1
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:GA
Mailing Address - Zip Code:31904-3432
Mailing Address - Country:US
Mailing Address - Phone:706-221-0185
Mailing Address - Fax:
Practice Address - Street 1:5636 WHITESVILLE RD STE D1
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:GA
Practice Address - Zip Code:31904-3432
Practice Address - Country:US
Practice Address - Phone:706-221-0185
Practice Address - Fax:706-221-0186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-08-09
Last Update Date:2018-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies