Provider Demographics
NPI:1932191947
Name:ADVANCED PAINCARE PC
Entity Type:Organization
Organization Name:ADVANCED PAINCARE PC
Other - Org Name:PATRIOT PAIN MANAGEMENT PC
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT ADVANCED PAINCARE
Authorized Official - Prefix:
Authorized Official - First Name:JEAN
Authorized Official - Middle Name:LOUISE
Authorized Official - Last Name:SANTO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:717-791-2860
Mailing Address - Street 1:18 STONE SPRING LANE
Mailing Address - Street 2:
Mailing Address - City:CAMP HILL
Mailing Address - State:PA
Mailing Address - Zip Code:17011
Mailing Address - Country:US
Mailing Address - Phone:717-791-2860
Mailing Address - Fax:717-703-0015
Practice Address - Street 1:97 N 36TH ST
Practice Address - Street 2:
Practice Address - City:CAMP HILL
Practice Address - State:PA
Practice Address - Zip Code:17011-2762
Practice Address - Country:US
Practice Address - Phone:717-791-2860
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-16
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207L00000X, 207LP2900X, 208VP0014X
PAMD035037E207L00000X, 207LP2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA605369OtherMEDICARE
PA7581000001OtherMEDICARE NSC
PA605369OtherMEDICARE