Provider Demographics
NPI:1780745596
Name:PAIN MANAGEMENT CONSULTANTS, LLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KATHY
Authorized Official - Middle Name:
Authorized Official - Last Name:WOLFSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-635-2775
Mailing Address - Street 1:1169 EASTERN PKWY
Mailing Address - Street 2:SUITE 2211
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40217-1417
Mailing Address - Country:US
Mailing Address - Phone:502-635-2775
Mailing Address - Fax:502-371-0475
Practice Address - Street 1:1169 EASTERN PKWY
Practice Address - Street 2:SUITE 2211
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40217-1417
Practice Address - Country:US
Practice Address - Phone:502-635-2775
Practice Address - Fax:502-371-0475
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2024-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X
KY22581208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65903056Medicaid
KY64225816Medicaid
KY78903192Medicaid
KY7100130090Medicaid
KYDA3323OtherMEDICARE RR
KY65903056Medicaid
KY6968Medicare PIN
KY64225816Medicaid
KYDA3323Medicare PIN
KYC73385Medicare UPIN