Provider Demographics
NPI:1922772888
Name:PAIN MANAGEMENT COMPANY LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT COMPANY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-259-6209
Mailing Address - Street 1:1250 EASTON RD STE 201N
Mailing Address - Street 2:
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1421
Mailing Address - Country:US
Mailing Address - Phone:215-922-2502
Mailing Address - Fax:
Practice Address - Street 1:1250 EASTON RD STE 201N
Practice Address - Street 2:
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1421
Practice Address - Country:US
Practice Address - Phone:215-922-2502
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:PAIN MANAGEMENT COMPANY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2021-08-04
Last Update Date:2021-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
DE1000038543Medicaid
PA100929842-0002Medicaid