Provider Demographics
NPI:1831319870
Name:OSTEOPATHIC PAIN MANAGEMENT SERVICES LLC
Entity Type:Organization
Organization Name:OSTEOPATHIC PAIN MANAGEMENT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSCIAN OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:L
Authorized Official - Last Name:HASTINGS
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:607-748-9001
Mailing Address - Street 1:153 OAKDALE RD
Mailing Address - Street 2:
Mailing Address - City:JOHNSON CITY
Mailing Address - State:NY
Mailing Address - Zip Code:13790-1007
Mailing Address - Country:US
Mailing Address - Phone:607-748-9001
Mailing Address - Fax:607-748-8546
Practice Address - Street 1:153 OAKDALE RD
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:NY
Practice Address - Zip Code:13790-1007
Practice Address - Country:US
Practice Address - Phone:607-748-9001
Practice Address - Fax:607-748-8546
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-01
Last Update Date:2019-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY200637208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NYDD2889Medicare ID - Type Unspecified
NYG31917Medicare UPIN