Provider Demographics
NPI:1922111764
Name:ERIE SPINE AND PAIN MANAGEMENT PC
Entity Type:Organization
Organization Name:ERIE SPINE AND PAIN MANAGEMENT PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:PREETHI
Authorized Official - Middle Name:
Authorized Official - Last Name:RAI
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:814-454-4599
Mailing Address - Street 1:6133 VOLKMAN ROAD
Mailing Address - Street 2:
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16506
Mailing Address - Country:US
Mailing Address - Phone:814-454-4599
Mailing Address - Fax:814-454-4503
Practice Address - Street 1:2620 SIGSBEE STREET
Practice Address - Street 2:
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16508
Practice Address - Country:US
Practice Address - Phone:814-454-4599
Practice Address - Fax:814-454-4503
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-16
Last Update Date:2007-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1341793OtherHIGHMARK BLUE SHIELD
PA1341793OtherHIGHMARK BLUE SHIELD