Provider Demographics
NPI:1720212541
Name:PAIN CENTERS OF AMERICA LLC
Entity Type:Organization
Organization Name:PAIN CENTERS OF AMERICA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP, COO
Authorized Official - Prefix:MS
Authorized Official - First Name:JONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-691-4123
Mailing Address - Street 1:1515 KENSINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14215-1436
Mailing Address - Country:US
Mailing Address - Phone:716-691-4123
Mailing Address - Fax:
Practice Address - Street 1:1625 MEDICAL CENTER PT STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8721
Practice Address - Country:US
Practice Address - Phone:719-577-9063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-05-07
Last Update Date:2013-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty