Provider Demographics
NPI:1295055648
Name:PAIN BE-GONE ANESTHESIA SERVICES INC
Entity type:Organization
Organization Name:PAIN BE-GONE ANESTHESIA SERVICES INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PAIN SPECIALIST
Authorized Official - Prefix:MR
Authorized Official - First Name:GREGORY
Authorized Official - Middle Name:ALLEN
Authorized Official - Last Name:PEKKALA
Authorized Official - Suffix:
Authorized Official - Credentials:CRNA
Authorized Official - Phone:515-604-6618
Mailing Address - Street 1:PO BOX 265
Mailing Address - Street 2:
Mailing Address - City:HUMBOLDT
Mailing Address - State:IA
Mailing Address - Zip Code:50548-0265
Mailing Address - Country:US
Mailing Address - Phone:515-604-6618
Mailing Address - Fax:515-604-6627
Practice Address - Street 1:1001 12TH ST N
Practice Address - Street 2:
Practice Address - City:HUMBOLDT
Practice Address - State:IA
Practice Address - Zip Code:50548
Practice Address - Country:US
Practice Address - Phone:515-604-6618
Practice Address - Fax:515-604-6627
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-08
Last Update Date:2018-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA367500000X261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA6729480001Medicare NSC