Provider Demographics
NPI:1215977079
Name:CENTER FOR PAIN MANAGEMENT, P.A.
Entity type:Organization
Organization Name:CENTER FOR PAIN MANAGEMENT, P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:SAM
Authorized Official - Middle Name:
Authorized Official - Last Name:ELGHOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:320-230-7788
Mailing Address - Street 1:804 23RD ST S
Mailing Address - Street 2:
Mailing Address - City:SARTELL
Mailing Address - State:MN
Mailing Address - Zip Code:56377-4705
Mailing Address - Country:US
Mailing Address - Phone:320-230-7788
Mailing Address - Fax:320-230-7789
Practice Address - Street 1:804 23RD ST S
Practice Address - Street 2:
Practice Address - City:SARTELL
Practice Address - State:MN
Practice Address - Zip Code:56377-4705
Practice Address - Country:US
Practice Address - Phone:320-230-7788
Practice Address - Fax:320-230-7789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-08
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MNC04264Medicare ID - Type UnspecifiedMEDICARE GROUP NUMBER