Provider Demographics
NPI:1457770547
Name:PHYSICIANS INSTITUTE FOR PAIN MANAGEMENT ASC, LLC
Entity Type:Organization
Organization Name:PHYSICIANS INSTITUTE FOR PAIN MANAGEMENT ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:H
Authorized Official - Last Name:CAMPAGNA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:229-247-3300
Mailing Address - Street 1:3312 N OAK ST EXT SUITE F
Mailing Address - Street 2:
Mailing Address - City:VALDOSTA
Mailing Address - State:GA
Mailing Address - Zip Code:31602
Mailing Address - Country:US
Mailing Address - Phone:229-247-3300
Mailing Address - Fax:
Practice Address - Street 1:3312 N OAK STREET EXT STE F
Practice Address - Street 2:
Practice Address - City:VALDOSTA
Practice Address - State:GA
Practice Address - Zip Code:31605-1065
Practice Address - Country:US
Practice Address - Phone:229-247-3300
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-16
Last Update Date:2014-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA33806261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical