Provider Demographics
NPI:1811220304
Name:ADVANCED PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ALEXEY
Authorized Official - Middle Name:A
Authorized Official - Last Name:RYSKIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:435-656-0029
Mailing Address - Street 1:620 S 400 E STE 201
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84770-7060
Mailing Address - Country:US
Mailing Address - Phone:435-656-0029
Mailing Address - Fax:435-656-9144
Practice Address - Street 1:620 S 400 E STE 201
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770-7060
Practice Address - Country:US
Practice Address - Phone:435-656-0029
Practice Address - Fax:435-656-9144
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-09-15
Last Update Date:2009-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5566449-1205207LP2900X, 208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty