Provider Demographics
NPI:1205880242
Name:PAIN ASSOCIATES OF MERCED
Entity type:Organization
Organization Name:PAIN ASSOCIATES OF MERCED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GROUP PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:
Authorized Official - Last Name:THORDAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-724-0316
Mailing Address - Street 1:1390 E YOSEMITE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8221
Mailing Address - Country:US
Mailing Address - Phone:209-724-0316
Mailing Address - Fax:209-724-0318
Practice Address - Street 1:1390 E YOSEMITE AVE
Practice Address - Street 2:SUITE C
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95348
Practice Address - Country:US
Practice Address - Phone:209-724-0316
Practice Address - Fax:209-724-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-22
Last Update Date:2019-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZ64470ZOtherBLUE SHIELD OF CALIFORNIA
CA607297600OtherUS DEPT OF LABOR
CAGR0099950Medicaid
CAGR0099950Medicaid