Provider Demographics
NPI:1932139821
Name:PAIN MANAGEMENT MEDICAL CENTER
Entity Type:Organization
Organization Name:PAIN MANAGEMENT MEDICAL CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHAT
Authorized Official - Middle Name:FOUAD
Authorized Official - Last Name:MIKHAEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:562-595-0060
Mailing Address - Street 1:3545 LONG BEACH BLVD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90807-3941
Mailing Address - Country:US
Mailing Address - Phone:562-595-0060
Mailing Address - Fax:562-981-0916
Practice Address - Street 1:3545 LONG BEACH BLVD
Practice Address - Street 2:SUITE 105
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90807-3941
Practice Address - Country:US
Practice Address - Phone:562-595-0060
Practice Address - Fax:562-981-0916
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ592332ZOtherBLUE SHIELD
CAW11649AMedicare ID - Type UnspecifiedGROUP NUMBER
CAW11649Medicare ID - Type UnspecifiedGROUP NUMBER