Provider Demographics
NPI:1639981087
Name:SUPERIOR PAIN MANAGEMENT SC
Entity type:Organization
Organization Name:SUPERIOR PAIN MANAGEMENT SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:DAVIES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:218-310-4418
Mailing Address - Street 1:1420 LONDON RD STE 100
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55805-2437
Mailing Address - Country:US
Mailing Address - Phone:218-310-4418
Mailing Address - Fax:218-728-8554
Practice Address - Street 1:823 BELKNAP ST STE 106
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2974
Practice Address - Country:US
Practice Address - Phone:218-310-4418
Practice Address - Fax:218-728-8554
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-23
Last Update Date:2025-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain