Provider Demographics
NPI:1588974588
Name:GREATER PHILADELPHIA PAIN MANAGEMENT CENTER PC
Entity type:Organization
Organization Name:GREATER PHILADELPHIA PAIN MANAGEMENT CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:M
Authorized Official - Last Name:BAYZICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-957-5400
Mailing Address - Street 1:600 LOUIS DRIVE SUITE 202
Mailing Address - Street 2:GREATER PHILADELPHIA PAIN MANAGEMENT CENTER PC
Mailing Address - City:WARMINSTER
Mailing Address - State:PA
Mailing Address - Zip Code:18974
Mailing Address - Country:US
Mailing Address - Phone:215-957-5400
Mailing Address - Fax:215-957-5401
Practice Address - Street 1:2612 RHAWN STREET
Practice Address - Street 2:
Practice Address - City:PHILADELPHIA
Practice Address - State:PA
Practice Address - Zip Code:19152
Practice Address - Country:US
Practice Address - Phone:215-338-8555
Practice Address - Fax:215-957-5401
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-12
Last Update Date:2022-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD4254552081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA950467OtherHIGHMARK
PA0872975000OtherKEYSTONE/PC
PA0872975000OtherKEYSTONE/PC