Provider Demographics
NPI:1740685205
Name:PAIN MEDICINE CONSULTANTS, INC.
Entity type:Organization
Organization Name:PAIN MEDICINE CONSULTANTS, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:COOPER
Authorized Official - Last Name:LONGTON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:925-287-1256
Mailing Address - Street 1:2250 MORELLO AVE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:PLEASANT HILL
Mailing Address - State:CA
Mailing Address - Zip Code:94523-1860
Mailing Address - Country:US
Mailing Address - Phone:925-287-1256
Mailing Address - Fax:925-287-0913
Practice Address - Street 1:2250 MORELLO AVE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:PLEASANT HILL
Practice Address - State:CA
Practice Address - Zip Code:94523-1860
Practice Address - Country:US
Practice Address - Phone:925-287-1505
Practice Address - Fax:925-287-0913
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-27
Last Update Date:2014-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAG71946174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty