Provider Demographics
NPI:1710627237
Name:HARBOR INTERVENTIONAL PAIN CENTER, LLC
Entity Type:Organization
Organization Name:HARBOR INTERVENTIONAL PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:LESTER
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:413-218-1201
Mailing Address - Street 1:102 S TRAIL WAY # B9
Mailing Address - Street 2:
Mailing Address - City:POOLER
Mailing Address - State:GA
Mailing Address - Zip Code:31322-9815
Mailing Address - Country:US
Mailing Address - Phone:413-218-1201
Mailing Address - Fax:
Practice Address - Street 1:4849 PAULSEN ST STE 312
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4426
Practice Address - Country:US
Practice Address - Phone:413-218-1201
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-31
Last Update Date:2022-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty