Provider Demographics
NPI:1720138472
Name:PAIN MANAGEMENT CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA OR PAT
Authorized Official - Middle Name:J
Authorized Official - Last Name:CHUDOMELKA
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PHD
Authorized Official - Phone:402-445-4800
Mailing Address - Street 1:11819 MIRACLE HILLS DR
Mailing Address - Street 2:SUITE 202
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68154-4428
Mailing Address - Country:US
Mailing Address - Phone:402-445-4800
Mailing Address - Fax:402-445-4848
Practice Address - Street 1:11819 MIRACLE HILLS DR
Practice Address - Street 2:SUITE 202
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4428
Practice Address - Country:US
Practice Address - Phone:402-445-4800
Practice Address - Fax:402-445-4848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-12
Last Update Date:2017-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE20620208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NEF44681Medicare UPIN
NE270332Medicare ID - Type Unspecified
NE=========00Medicaid