Provider Demographics
NPI:1396791380
Name:PAIN AND PALLIATIVE CARE, LLC
Entity type:Organization
Organization Name:PAIN AND PALLIATIVE CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PPC, LLC
Authorized Official - Prefix:DR
Authorized Official - First Name:EDWARD
Authorized Official - Middle Name:P
Authorized Official - Last Name:HARGUS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:860-889-0759
Mailing Address - Street 1:111 SALEM TURNPIKE RD RT 82
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360-3408
Mailing Address - Country:US
Mailing Address - Phone:860-425-5900
Mailing Address - Fax:860-889-8780
Practice Address - Street 1:111 SALEM TURNPIKE RD RT 82
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360-3408
Practice Address - Country:US
Practice Address - Phone:860-425-5900
Practice Address - Fax:860-889-8780
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2013-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT021754207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT72000001Medicare ID - Type Unspecified