Provider Demographics
NPI:1841810686
Name:PAIN MANAGEMENT DEPOT INC
Entity type:Organization
Organization Name:PAIN MANAGEMENT DEPOT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:FRANKLIN
Authorized Official - Middle Name:
Authorized Official - Last Name:AKIOYAME
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:702-992-3563
Mailing Address - Street 1:2465 REYNOLDS AVE STE 301
Mailing Address - Street 2:
Mailing Address - City:N LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89030-7296
Mailing Address - Country:US
Mailing Address - Phone:702-992-3563
Mailing Address - Fax:725-204-5455
Practice Address - Street 1:811 S DECATUR BLVD
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89107-3933
Practice Address - Country:US
Practice Address - Phone:702-808-6501
Practice Address - Fax:702-685-8450
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-22
Last Update Date:2021-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV2600379066OtherDRIVERS LICENSE