Provider Demographics
NPI:1548692031
Name:PAIN DIAGNOSTICS & INTERVENTIONAL CARE LLC
Entity type:Organization
Organization Name:PAIN DIAGNOSTICS & INTERVENTIONAL CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:ANTHONY
Authorized Official - Last Name:PROVENZANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:412-860-4644
Mailing Address - Street 1:PO BOX 203
Mailing Address - Street 2:
Mailing Address - City:BRIDGEVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15017-0203
Mailing Address - Country:US
Mailing Address - Phone:412-221-7640
Mailing Address - Fax:412-490-9850
Practice Address - Street 1:301 OHIO RIVER BLVD
Practice Address - Street 2:SUITE 203
Practice Address - City:SEWICKLEY
Practice Address - State:PA
Practice Address - Zip Code:15143-1300
Practice Address - Country:US
Practice Address - Phone:412-221-7640
Practice Address - Fax:412-490-9850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-06
Last Update Date:2013-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty