Provider Demographics
NPI:1457098758
Name:PAIN 101 MEDICAL LLC
Entity Type:Organization
Organization Name:PAIN 101 MEDICAL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:REYNE
Authorized Official - Middle Name:
Authorized Official - Last Name:POLK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:833-724-6100
Mailing Address - Street 1:870 MCCLELLANDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:MC CLELLANDTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:15458-1253
Mailing Address - Country:US
Mailing Address - Phone:724-984-4273
Mailing Address - Fax:724-430-4925
Practice Address - Street 1:870 MCCLELLANDTOWN RD
Practice Address - Street 2:
Practice Address - City:MC CLELLANDTOWN
Practice Address - State:PA
Practice Address - Zip Code:15458-1253
Practice Address - Country:US
Practice Address - Phone:724-984-4273
Practice Address - Fax:724-430-4925
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-18
Last Update Date:2022-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies