Provider Demographics
NPI:1245290170
Name:ADVANCED PAIN CONTROL, LTD.
Entity type:Organization
Organization Name:ADVANCED PAIN CONTROL, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:GAHN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:314-768-8491
Mailing Address - Street 1:12345 W BEND DR
Mailing Address - Street 2:SUITE 302
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63128-2182
Mailing Address - Country:US
Mailing Address - Phone:314-768-0707
Mailing Address - Fax:314-768-0718
Practice Address - Street 1:601 WASHINGTON AVE
Practice Address - Street 2:390
Practice Address - City:NEWPORT
Practice Address - State:KY
Practice Address - Zip Code:41071-1986
Practice Address - Country:US
Practice Address - Phone:859-291-4800
Practice Address - Fax:859-655-8588
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-03-24
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR3L52208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC7810Medicare PIN