Provider Demographics
NPI:1720372311
Name:ADVANCED PAIN CARE AND WELLNESS CENTER, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN CARE AND WELLNESS CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ELIZABETH
Authorized Official - Middle Name:ANGELA
Authorized Official - Last Name:RUSSO-STRINGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:225-243-5603
Mailing Address - Street 1:1234 DEL ESTE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DENHAM SPRINGS
Mailing Address - State:LA
Mailing Address - Zip Code:70726-4828
Mailing Address - Country:US
Mailing Address - Phone:225-243-5603
Mailing Address - Fax:
Practice Address - Street 1:1234 DEL ESTE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:DENHAM SPRINGS
Practice Address - State:LA
Practice Address - Zip Code:70726-4828
Practice Address - Country:US
Practice Address - Phone:225-243-5603
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-01
Last Update Date:2011-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAMD.201475208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty