Provider Demographics
NPI:1780707836
Name:PAIN TREATMENT CENTER ANESTHESIOLOGISTS PC
Entity type:Organization
Organization Name:PAIN TREATMENT CENTER ANESTHESIOLOGISTS PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ATTAS
Authorized Official - Middle Name:
Authorized Official - Last Name:BOUTROUS
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:701-223-7822
Mailing Address - Street 1:202 E GREENFIELD LN STE 100
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:ND
Mailing Address - Zip Code:58503-6597
Mailing Address - Country:US
Mailing Address - Phone:701-223-7822
Mailing Address - Fax:701-223-7844
Practice Address - Street 1:202 E GREENFIELD LN STE 100
Practice Address - Street 2:
Practice Address - City:BISMARCK
Practice Address - State:ND
Practice Address - Zip Code:58503-6597
Practice Address - Country:US
Practice Address - Phone:701-223-7822
Practice Address - Fax:701-223-7844
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-06
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND05349001OtherBCBS GROUP
ND1463006Medicaid
ND11465Medicaid
ND71091Medicare ID - Type UnspecifiedGROUP