Provider Demographics
NPI:1013966407
Name:HENDRICKSON & HUNT PAIN MANAGEMENT PHYSICIANS, A CORP
Entity Type:Organization
Organization Name:HENDRICKSON & HUNT PAIN MANAGEMENT PHYSICIANS, A CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:HUNT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:916-984-3899
Mailing Address - Street 1:PO BOX 34120
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89533-4120
Mailing Address - Country:US
Mailing Address - Phone:775-747-5050
Mailing Address - Fax:775-329-8596
Practice Address - Street 1:2350 E BIDWELL ST
Practice Address - Street 2:
Practice Address - City:FOLSOM
Practice Address - State:CA
Practice Address - Zip Code:95630-3455
Practice Address - Country:US
Practice Address - Phone:916-984-3899
Practice Address - Fax:916-284-6522
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-10
Last Update Date:2019-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAA63152OtherDR. HUNT'S MEDICARE PIN
CAG83722OtherDR. HENDRICKSON'S MEDICARE PIN
CAZZZ03817ZMedicare ID - Type UnspecifiedMEDICARE GROUP NUMBER