Provider Demographics
NPI:1972613859
Name:BRANDYWINE VALLEY PAIN CONTROL CENTER, INC.
Entity Type:Organization
Organization Name:BRANDYWINE VALLEY PAIN CONTROL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WINIFRED
Authorized Official - Middle Name:C
Authorized Official - Last Name:MEALL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-280-0360
Mailing Address - Street 1:460 CREAMERY WAY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2533
Mailing Address - Country:US
Mailing Address - Phone:610-280-0340
Mailing Address - Fax:610-280-0750
Practice Address - Street 1:460 CREAMERY WAY
Practice Address - Street 2:SUITE 102
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2533
Practice Address - Country:US
Practice Address - Phone:610-280-0340
Practice Address - Fax:610-280-0750
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2007-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
542691Medicare ID - Type Unspecified