Provider Demographics
NPI:1548522774
Name:NEUROPATHY AND PAIN CENTERS OF AMERICA HOLDING COMPANY, LLC
Entity type:Organization
Organization Name:NEUROPATHY AND PAIN CENTERS OF AMERICA HOLDING COMPANY, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:586-531-8882
Mailing Address - Street 1:4350 DELL RD
Mailing Address - Street 2:STE. J
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-8137
Mailing Address - Country:US
Mailing Address - Phone:586-531-8882
Mailing Address - Fax:
Practice Address - Street 1:300 W WASHINGTON AVE
Practice Address - Street 2:STE. 250
Practice Address - City:JACKSON
Practice Address - State:MI
Practice Address - Zip Code:49201-2180
Practice Address - Country:US
Practice Address - Phone:586-531-8882
Practice Address - Fax:517-676-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-13
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI4301100643208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty