Provider Demographics
NPI:1154749497
Name:CONSULTANTS IN PAIN MANAGEMENT
Entity type:Organization
Organization Name:CONSULTANTS IN PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMIN
Authorized Official - Prefix:
Authorized Official - First Name:GINA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:DILUZIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:814-459-0585
Mailing Address - Street 1:2409 STATE ST
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:ERIE
Mailing Address - State:PA
Mailing Address - Zip Code:16503-1856
Mailing Address - Country:US
Mailing Address - Phone:814-459-0585
Mailing Address - Fax:814-455-0239
Practice Address - Street 1:2409 STATE ST
Practice Address - Street 2:2ND FLOOR
Practice Address - City:ERIE
Practice Address - State:PA
Practice Address - Zip Code:16503-1856
Practice Address - Country:US
Practice Address - Phone:814-459-0585
Practice Address - Fax:814-455-0239
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-03
Last Update Date:2015-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PA261QM1300X, 261QM2500X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-SpecialtyGroup - Single Specialty
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA347727Medicare PIN