Provider Demographics
NPI:1528354420
Name:TWIN CITY PAIN CENTER- WEST, PLLC
Entity type:Organization
Organization Name:TWIN CITY PAIN CENTER- WEST, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ARELIS
Authorized Official - Middle Name:
Authorized Official - Last Name:GARCIA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-727-0054
Mailing Address - Street 1:1 W LAKE ST
Mailing Address - Street 2:SUITE 195B
Mailing Address - City:MINNEAPOLIS
Mailing Address - State:MN
Mailing Address - Zip Code:55408-3154
Mailing Address - Country:US
Mailing Address - Phone:612-276-5722
Mailing Address - Fax:612-276-5721
Practice Address - Street 1:1 W LAKE ST
Practice Address - Street 2:SUITE 195B
Practice Address - City:MINNEAPOLIS
Practice Address - State:MN
Practice Address - Zip Code:55408-3154
Practice Address - Country:US
Practice Address - Phone:612-276-5722
Practice Address - Fax:612-276-5721
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN28662207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty