Provider Demographics
NPI:1265432637
Name:ADVANCED PAIN MANAGEMENT SPECIALISTS, PC
Entity type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:BARBARA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-970-1030
Mailing Address - Street 1:11 GALLAGHER DR
Mailing Address - Street 2:
Mailing Address - City:PLAINS
Mailing Address - State:PA
Mailing Address - Zip Code:18705-1146
Mailing Address - Country:US
Mailing Address - Phone:570-970-1030
Mailing Address - Fax:570-270-0577
Practice Address - Street 1:11 GALLAGHER DR
Practice Address - Street 2:
Practice Address - City:PLAINS
Practice Address - State:PA
Practice Address - Zip Code:18705-1146
Practice Address - Country:US
Practice Address - Phone:570-970-1030
Practice Address - Fax:570-270-0577
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-28
Last Update Date:2013-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA807508OtherFIRST PRIORITY PROVIDER N
PA2341896OtherAETNA PROVIDER NUMBER
PA0017739590004Medicaid
PA747842OtherBLUE SHIELD PROVIDER NUMB
PA747842OtherBLUE SHIELD PROVIDER NUMB
PA807508OtherFIRST PRIORITY PROVIDER N