Provider Demographics
NPI:1427292101
Name:HEAG PAIN MANAGEMENT CENTER PA
Entity type:Organization
Organization Name:HEAG PAIN MANAGEMENT CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:KWADWO
Authorized Official - Middle Name:
Authorized Official - Last Name:GYARTENG-DAKWA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:919-220-0107
Mailing Address - Street 1:1305 W WENDOVER AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27408-8100
Mailing Address - Country:US
Mailing Address - Phone:336-282-0132
Mailing Address - Fax:336-282-6962
Practice Address - Street 1:1305 W WENDOVER AVE STE A
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27408
Practice Address - Country:US
Practice Address - Phone:336-282-0132
Practice Address - Fax:336-282-6962
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-27
Last Update Date:2023-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC130447305S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes305S00000XManaged Care OrganizationsPoint of Service