Provider Demographics
NPI:1134268857
Name:PAIN MANAGEMENT ASSOCIATES USA
Entity type:Organization
Organization Name:PAIN MANAGEMENT ASSOCIATES USA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:PAMELA
Authorized Official - Middle Name:J
Authorized Official - Last Name:BORVAN
Authorized Official - Suffix:
Authorized Official - Credentials:BSN
Authorized Official - Phone:815-462-8602
Mailing Address - Street 1:328 E LINCOLN HWY
Mailing Address - Street 2:SUITE E
Mailing Address - City:NEW LENOX
Mailing Address - State:IL
Mailing Address - Zip Code:60451-1849
Mailing Address - Country:US
Mailing Address - Phone:815-462-8602
Mailing Address - Fax:815-462-8471
Practice Address - Street 1:328 E LINCOLN HWY
Practice Address - Street 2:SUITE E
Practice Address - City:NEW LENOX
Practice Address - State:IL
Practice Address - Zip Code:60451-1849
Practice Address - Country:US
Practice Address - Phone:815-462-8602
Practice Address - Fax:815-462-8471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-06
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
207LP2900X
IL207Q00000X, 367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Not Answered207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty
Not Answered367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified RegisteredGroup - Single Specialty