Provider Demographics
NPI:1972553402
Name:PREMIER PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:PREMIER PAIN MANAGEMENT LLC
Other - Org Name:SPINAL PAIN CENTRE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MUJAHED
Authorized Official - Middle Name:BUD
Authorized Official - Last Name:LATEEF
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-466-7246
Mailing Address - Street 1:PO BOX 13166
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15243-0166
Mailing Address - Country:US
Mailing Address - Phone:844-252-7246
Mailing Address - Fax:
Practice Address - Street 1:110 ROESSLER RD
Practice Address - Street 2:SUITE D100
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15220-1016
Practice Address - Country:US
Practice Address - Phone:412-466-7246
Practice Address - Fax:866-530-7246
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-12
Last Update Date:2020-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1015652330001Medicaid
PA1015652330001Medicaid