Provider Demographics
NPI:1841395944
Name:PAIN AND SPINE MEDICINE CENTER OF THE CENTRAL COAST
Entity Type:Organization
Organization Name:PAIN AND SPINE MEDICINE CENTER OF THE CENTRAL COAST
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:W
Authorized Official - Last Name:SHEPLAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:805-434-0781
Mailing Address - Street 1:1105 LAS TABLAS RD
Mailing Address - Street 2:SUITE D
Mailing Address - City:TEMPLETON
Mailing Address - State:CA
Mailing Address - Zip Code:93465-9731
Mailing Address - Country:US
Mailing Address - Phone:805-434-0781
Mailing Address - Fax:805-434-0489
Practice Address - Street 1:1105 LAS TABLAS RD
Practice Address - Street 2:SUITE D
Practice Address - City:TEMPLETON
Practice Address - State:CA
Practice Address - Zip Code:93465-9731
Practice Address - Country:US
Practice Address - Phone:805-434-0781
Practice Address - Fax:805-434-0489
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-13
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6141280001Medicare NSC