Provider Demographics
NPI:1215083886
Name:PAIN TREATMENT CENTERS, LLC
Entity type:Organization
Organization Name:PAIN TREATMENT CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JONI
Authorized Official - Middle Name:G
Authorized Official - Last Name:HYRICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:716-446-5928
Mailing Address - Street 1:1625 MEDICAL CENTER PT STE 240
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80907-8721
Mailing Address - Country:US
Mailing Address - Phone:719-577-9063
Mailing Address - Fax:716-577-9124
Practice Address - Street 1:1625 MEDICAL CENTER PT STE 240
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80907-8721
Practice Address - Country:US
Practice Address - Phone:719-577-9063
Practice Address - Fax:716-577-9124
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-26
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1173261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
COA71036Medicare ID - Type Unspecified
COX41167Medicare UPIN