Provider Demographics
NPI:1801804612
Name:PAIN CENTER OF WESTERN PENNSYLVANIA, INC
Entity type:Organization
Organization Name:PAIN CENTER OF WESTERN PENNSYLVANIA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARY ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:WEINER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:724-342-1833
Mailing Address - Street 1:PO BOX 1032
Mailing Address - Street 2:
Mailing Address - City:HERMITAGE
Mailing Address - State:PA
Mailing Address - Zip Code:16148-0032
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3120 HIGHLAND RD
Practice Address - Street 2:SUITE 102
Practice Address - City:HERMITAGE
Practice Address - State:PA
Practice Address - Zip Code:16148-4512
Practice Address - Country:US
Practice Address - Phone:724-342-1833
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-04
Last Update Date:2012-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0012389700026Medicaid
PA540652Medicare PIN