Provider Demographics
NPI:1760639058
Name:ADVANCED PAIN MODALITIES, PLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MODALITIES, PLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:LAKSHMAN
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLLAPALLI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:480-756-6789
Mailing Address - Street 1:3195 W RAY RD
Mailing Address - Street 2:SUITE #1
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-2417
Mailing Address - Country:US
Mailing Address - Phone:480-756-6789
Mailing Address - Fax:480-246-8902
Practice Address - Street 1:3195 W RAY RD
Practice Address - Street 2:SUITE #1
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2417
Practice Address - Country:US
Practice Address - Phone:480-756-6789
Practice Address - Fax:480-246-8902
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2023-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ20264207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ125195Medicare PIN