Provider Demographics
NPI:1861752081
Name:PAIN SOLUTION CENTERS OF PHILADELPHIA
Entity type:Organization
Organization Name:PAIN SOLUTION CENTERS OF PHILADELPHIA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:F
Authorized Official - Last Name:FICCHI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:215-750-9600
Mailing Address - Street 1:PO BOX 1006
Mailing Address - Street 2:
Mailing Address - City:BENSALEM
Mailing Address - State:PA
Mailing Address - Zip Code:19020-5006
Mailing Address - Country:US
Mailing Address - Phone:215-750-9600
Mailing Address - Fax:267-332-0948
Practice Address - Street 1:3070 BRISTOL PIKE
Practice Address - Street 2:BLDG#1, SUITE 215
Practice Address - City:BENSALEM
Practice Address - State:PA
Practice Address - Zip Code:19020-5364
Practice Address - Country:US
Practice Address - Phone:215-750-9600
Practice Address - Fax:267-332-0948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-05-22
Last Update Date:2015-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOS3881L320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA25407Medicare PIN
PAC27804Medicare UPIN