Provider Demographics
NPI:1790994838
Name:SOUTH PHILADELPHIA PAIN MANAGEMENT
Entity Type:Organization
Organization Name:SOUTH PHILADELPHIA PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING
Authorized Official - Prefix:
Authorized Official - First Name:MINDY
Authorized Official - Middle Name:
Authorized Official - Last Name:GUSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-750-9600
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5006
Mailing Address - Country:US
Mailing Address - Phone:215-755-7595
Mailing Address - Fax:215-755-7608
Practice Address - Street 1:1732 S BROAD ST
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19145-2321
Practice Address - Country:US
Practice Address - Phone:215-755-7595
Practice Address - Fax:215-755-7608
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-22
Last Update Date:2009-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty