Provider Demographics
NPI:1902240054
Name:PAIN MANAGEMENT CARE, P.C.
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CARE, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SOLE PROPRIETOR
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:G
Authorized Official - Last Name:GLAZIER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:574-247-4682
Mailing Address - Street 1:2106 IRONWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:SOUTH BEND
Mailing Address - State:IN
Mailing Address - Zip Code:46635-1864
Mailing Address - Country:US
Mailing Address - Phone:574-247-4682
Mailing Address - Fax:574-247-4785
Practice Address - Street 1:707 N RIVER DR
Practice Address - Street 2:SUITE C
Practice Address - City:MARION
Practice Address - State:IN
Practice Address - Zip Code:46952-2765
Practice Address - Country:US
Practice Address - Phone:765-662-0155
Practice Address - Fax:765-662-0166
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-19
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01024859A208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN100343010AMedicaid
C25567Medicare UPIN
IN735300Medicare PIN