Provider Demographics
NPI:1881852598
Name:PAIN MANAGEMENT ASSOCIATES
Entity Type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES
Other - Org Name:OAKTREE MEDICAL CENTRE, PC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:MCCOLLUM
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:864-343-2611
Mailing Address - Street 1:PO BOX 484
Mailing Address - Street 2:
Mailing Address - City:EASLEY
Mailing Address - State:SC
Mailing Address - Zip Code:29641-0484
Mailing Address - Country:US
Mailing Address - Phone:864-855-1633
Mailing Address - Fax:864-855-1323
Practice Address - Street 1:205 CENTRAL PARK LN
Practice Address - Street 2:SUITE 7A
Practice Address - City:SENECA
Practice Address - State:SC
Practice Address - Zip Code:29678
Practice Address - Country:US
Practice Address - Phone:864-882-6518
Practice Address - Fax:864-882-2410
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OAKTREE MEDICAL CENTRE, PC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC6089Medicare PIN