Provider Demographics
NPI:1689666315
Name:PAIN CARE PROFESSIONALS, INC.
Entity Type:Organization
Organization Name:PAIN CARE PROFESSIONALS, INC.
Other - Org Name:PAIN CARE GROUP, INC.
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:WES
Authorized Official - Middle Name:
Authorized Official - Last Name:PROKOP
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-642-3527
Mailing Address - Street 1:PO BOX 237
Mailing Address - Street 2:
Mailing Address - City:WYNNEWOOD
Mailing Address - State:PA
Mailing Address - Zip Code:19096-0237
Mailing Address - Country:US
Mailing Address - Phone:610-642-3527
Mailing Address - Fax:610-795-7376
Practice Address - Street 1:HAHNEMANN UNIVERSITY HOSPITAL PAIN CLINIC
Practice Address - Street 2:BROAD & VINE ST., 4TH FLOOR SOUTH TOWER
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19096
Practice Address - Country:US
Practice Address - Phone:610-795-7375
Practice Address - Fax:610-795-7376
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-18
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA090236Medicare ID - Type Unspecified