Provider Demographics
NPI:1689957060
Name:NM PAIN CARE SPECIALIST, LLC
Entity Type:Organization
Organization Name:NM PAIN CARE SPECIALIST, LLC
Other - Org Name:USA PAIN CLINICS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FRANCHISEE
Authorized Official - Prefix:
Authorized Official - First Name:ROB
Authorized Official - Middle Name:
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:505-896-9412
Mailing Address - Street 1:914 PINEHURST RD SE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:RIO RANCHO
Mailing Address - State:NM
Mailing Address - Zip Code:87124-2219
Mailing Address - Country:US
Mailing Address - Phone:505-896-9412
Mailing Address - Fax:505-896-2505
Practice Address - Street 1:914 PINEHURST RD SE
Practice Address - Street 2:SUITE 102
Practice Address - City:RIO RANCHO
Practice Address - State:NM
Practice Address - Zip Code:87124-2219
Practice Address - Country:US
Practice Address - Phone:505-896-9412
Practice Address - Fax:505-896-9461
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-09-22
Last Update Date:2014-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty