Provider Demographics
NPI:1801936125
Name:PAIN MANAGEMENT COMPANY LLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT COMPANY LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT & CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUNLEAVY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-922-2502
Mailing Address - Street 1:1250 EASTON RD
Mailing Address - Street 2:SUITE 201 N
Mailing Address - City:HORSHAM
Mailing Address - State:PA
Mailing Address - Zip Code:19044-1416
Mailing Address - Country:US
Mailing Address - Phone:215-922-2502
Mailing Address - Fax:215-922-0275
Practice Address - Street 1:1250 EASTON RD
Practice Address - Street 2:SUITE 201 N
Practice Address - City:HORSHAM
Practice Address - State:PA
Practice Address - Zip Code:19044-1416
Practice Address - Country:US
Practice Address - Phone:215-922-2502
Practice Address - Fax:215-922-0275
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-07
Last Update Date:2015-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP4813451835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA100929842-0001Medicaid
PA3983017OtherNCPDP