Provider Demographics
NPI:1255863031
Name:PAIN MEDICINE OF YORK, LLC
Entity type:Organization
Organization Name:PAIN MEDICINE OF YORK, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:FLORENTINA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAYKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-467-4055
Mailing Address - Street 1:1497A S QUEEN ST
Mailing Address - Street 2:
Mailing Address - City:YORK
Mailing Address - State:PA
Mailing Address - Zip Code:17403-3852
Mailing Address - Country:US
Mailing Address - Phone:717-848-3979
Mailing Address - Fax:717-668-8967
Practice Address - Street 1:301 E. PLEASANT VALLEY BLVD.
Practice Address - Street 2:
Practice Address - City:ALTOONA
Practice Address - State:PA
Practice Address - Zip Code:16602
Practice Address - Country:US
Practice Address - Phone:814-944-5835
Practice Address - Fax:814-944-9184
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2019-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty