Provider Demographics
NPI:1336351501
Name:PAIN MANAGEMENT & SPINAL CARE, LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT & SPINAL CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CARLO LONGOBARDO
Authorized Official - Prefix:DR
Authorized Official - First Name:CARLO
Authorized Official - Middle Name:
Authorized Official - Last Name:LONGOBARDO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:508-795-1810
Mailing Address - Street 1:291 LINCOLN ST
Mailing Address - Street 2:STE. 100
Mailing Address - City:WORCESTER
Mailing Address - State:MA
Mailing Address - Zip Code:01605-3643
Mailing Address - Country:US
Mailing Address - Phone:508-795-1810
Mailing Address - Fax:508-795-1282
Practice Address - Street 1:291 LINCOLN ST
Practice Address - Street 2:STE. 100
Practice Address - City:WORCESTER
Practice Address - State:MA
Practice Address - Zip Code:01605-3643
Practice Address - Country:US
Practice Address - Phone:508-795-1810
Practice Address - Fax:508-795-1282
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAMA-2086111N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MAPAY49099Medicare ID - Type UnspecifiedMEDICARE PART B GROUP NUM
MALOY45587Medicare ID - Type UnspecifiedMEDICARE PART B IND. NUM
MA93508Medicare UPIN