Provider Demographics
NPI:1790226595
Name:PRIME PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:PRIME PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AKINTOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLUGBODI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-568-5078
Mailing Address - Street 1:301 S 7TH ST
Mailing Address - Street 2:SUITE 310
Mailing Address - City:READING
Mailing Address - State:PA
Mailing Address - Zip Code:19602-2432
Mailing Address - Country:US
Mailing Address - Phone:610-568-5078
Mailing Address - Fax:
Practice Address - Street 1:301 S 7TH ST
Practice Address - Street 2:SUITE 310
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19602-2432
Practice Address - Country:US
Practice Address - Phone:610-568-5078
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-13
Last Update Date:2017-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD446378208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty