Provider Demographics
NPI:1770196552
Name:THE PAIN CLINIC, INC.
Entity Type:Organization
Organization Name:THE PAIN CLINIC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TABBY
Authorized Official - Middle Name:
Authorized Official - Last Name:LUCAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:702-368-0508
Mailing Address - Street 1:5445 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89146-0308
Mailing Address - Country:US
Mailing Address - Phone:702-368-0508
Mailing Address - Fax:702-368-2049
Practice Address - Street 1:5445 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89146-0308
Practice Address - Country:US
Practice Address - Phone:702-368-0508
Practice Address - Fax:702-368-2049
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE PAIN CLINIC, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-31
Last Update Date:2020-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Single Specialty