Provider Demographics
NPI:1669897724
Name:PAIN MANAGEMENT ASSOCIATES OF NORTH CAROLINA
Entity type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES OF NORTH CAROLINA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:GRENADA
Authorized Official - Middle Name:
Authorized Official - Last Name:NEIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:864-343-2643
Mailing Address - Street 1:PO BOX 1254
Mailing Address - Street 2:
Mailing Address - City:ARDEN
Mailing Address - State:NC
Mailing Address - Zip Code:28704-1254
Mailing Address - Country:US
Mailing Address - Phone:864-343-2643
Mailing Address - Fax:
Practice Address - Street 1:2270 HENDERSONVILLE RD
Practice Address - Street 2:
Practice Address - City:ARDEN
Practice Address - State:NC
Practice Address - Zip Code:28704-2753
Practice Address - Country:US
Practice Address - Phone:864-343-2643
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-02-26
Last Update Date:2014-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain