Provider Demographics
NPI:1689878118
Name:PAIN AND LASER CENTE PA
Entity Type:Organization
Organization Name:PAIN AND LASER CENTE PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHELLE
Authorized Official - Middle Name:
Authorized Official - Last Name:APPLING
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:910-223-7246
Mailing Address - Street 1:PO BOX 40107
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28309-0107
Mailing Address - Country:US
Mailing Address - Phone:910-223-7246
Mailing Address - Fax:910-223-7247
Practice Address - Street 1:1840 OWEN DRIVE
Practice Address - Street 2:SUITE 103
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28304-3455
Practice Address - Country:US
Practice Address - Phone:910-223-7246
Practice Address - Fax:910-223-7247
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200200534207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC89132E7Medicaid
NC5907002Medicaid
NC232106Medicare PIN
NCA72571Medicare UPIN
NC2005511Medicare ID - Type Unspecified