Provider Demographics
NPI:1154375848
Name:PAIN MEDICINE SPECIALISTS, PC
Entity type:Organization
Organization Name:PAIN MEDICINE SPECIALISTS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:EARL
Authorized Official - Last Name:GUSA
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:215-712-2545
Mailing Address - Street 1:1300 HORIZON DR
Mailing Address - Street 2:SUITE 101
Mailing Address - City:CHALFONT
Mailing Address - State:PA
Mailing Address - Zip Code:18914-3970
Mailing Address - Country:US
Mailing Address - Phone:215-712-2545
Mailing Address - Fax:215-712-2540
Practice Address - Street 1:1300 HORIZON DR
Practice Address - Street 2:SUITE 101
Practice Address - City:CHALFONT
Practice Address - State:PA
Practice Address - Zip Code:18914-3970
Practice Address - Country:US
Practice Address - Phone:215-712-2545
Practice Address - Fax:215-712-2540
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-19
Last Update Date:2014-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD052249L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA054360Medicare ID - Type Unspecified