Provider Demographics
NPI:1265791057
Name:SOMERSET REGIONAL PAIN CENTER LLC
Entity type:Organization
Organization Name:SOMERSET REGIONAL PAIN CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:EZEKIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:AKANDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:606-677-0683
Mailing Address - Street 1:355 LANGDON ST
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:KY
Mailing Address - Zip Code:42503-2792
Mailing Address - Country:US
Mailing Address - Phone:606-677-0683
Mailing Address - Fax:606-677-0694
Practice Address - Street 1:355 LANGDON ST
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:KY
Practice Address - Zip Code:42503-2792
Practice Address - Country:US
Practice Address - Phone:606-677-0683
Practice Address - Fax:606-677-0694
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-14
Last Update Date:2014-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYH89023Medicare PIN