Provider Demographics
NPI:1699768713
Name:ADVANCED PAIN MANAGEMENT
Entity type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PREDISENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ROLAND
Authorized Official - Middle Name:D
Authorized Official - Last Name:REINHART
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:760-776-7520
Mailing Address - Street 1:39700 BOB HOPE DR
Mailing Address - Street 2:SUITE 204
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270-3267
Mailing Address - Country:US
Mailing Address - Phone:760-776-7520
Mailing Address - Fax:760-776-7521
Practice Address - Street 1:39700 BOB HOPE DR
Practice Address - Street 2:SUITE 204
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270-3267
Practice Address - Country:US
Practice Address - Phone:760-776-7520
Practice Address - Fax:760-776-7521
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-24
Last Update Date:2009-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA250000753261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAZZZH3320ZOtherBS PROVIDER #
CA490004885OtherMC RAIL ROAD
CA051476OtherBC PROVIDER #
CAZZZ18705ZMedicare PIN