Provider Demographics
NPI:1790841674
Name:PARK PAIN & REHAB CENTER INC
Entity Type:Organization
Organization Name:PARK PAIN & REHAB CENTER INC
Other - Org Name:JOHN I PARK MD
Other - Org Type:Other Name
Authorized Official - Title/Position:MEDICAL DOCTOR PRIVATE PRACTICE
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:I
Authorized Official - Last Name:PARK
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:724-887-7421
Mailing Address - Street 1:109 CROSSROADS ROAD
Mailing Address - Street 2:SUITE 6
Mailing Address - City:SCOTTDALE
Mailing Address - State:PA
Mailing Address - Zip Code:15683
Mailing Address - Country:US
Mailing Address - Phone:724-887-7421
Mailing Address - Fax:724-887-4145
Practice Address - Street 1:109 CROSSROADS ROAD
Practice Address - Street 2:SUITE 6
Practice Address - City:SCOTTDALE
Practice Address - State:PA
Practice Address - Zip Code:15683
Practice Address - Country:US
Practice Address - Phone:724-887-7421
Practice Address - Fax:724-887-4145
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD034892E208100000X, 208VP0014X, 246ZE0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Not Answered246ZE0600XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherElectroneurodiagnosticGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
197526OtherHIGHMARK
PA0011173760007Medicaid
C33311Medicare UPIN
087791Medicare ID - Type Unspecified