Provider Demographics
NPI:1770617938
Name:PAIN DOC ANESTHESIOLOGY PC
Entity type:Organization
Organization Name:PAIN DOC ANESTHESIOLOGY PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:SHAIRD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:269-580-8011
Mailing Address - Street 1:4672 BECKLEY RD
Mailing Address - Street 2:
Mailing Address - City:BATTLE CREEK
Mailing Address - State:MI
Mailing Address - Zip Code:49015-7932
Mailing Address - Country:US
Mailing Address - Phone:269-580-8011
Mailing Address - Fax:269-580-8013
Practice Address - Street 1:4672 BECKLEY RD
Practice Address - Street 2:
Practice Address - City:BATTLE CREEK
Practice Address - State:MI
Practice Address - Zip Code:49015-7932
Practice Address - Country:US
Practice Address - Phone:269-580-8011
Practice Address - Fax:269-580-8013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-16
Last Update Date:2017-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301060535207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI0501316062OtherBCBS OF MICHIGAN
MI335448249OtherCHAMPUS TRICARE
MI050064125OtherRR MEDICARE
MI3485077Medicaid
MI0N98970Medicare ID - Type UnspecifiedMEDICARE ID