Provider Demographics
NPI:1720108939
Name:ADVANCED PAIN TREATMENT CENTER
Entity type:Organization
Organization Name:ADVANCED PAIN TREATMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PRAGYA
Authorized Official - Middle Name:B
Authorized Official - Last Name:GUPTA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-331-4159
Mailing Address - Street 1:162 BARNWOOD DR
Mailing Address - Street 2:
Mailing Address - City:EDGEWOOD
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2501
Mailing Address - Country:US
Mailing Address - Phone:859-331-4159
Mailing Address - Fax:859-331-4163
Practice Address - Street 1:162 BARNWOOD DR
Practice Address - Street 2:
Practice Address - City:EDGEWOOD
Practice Address - State:KY
Practice Address - Zip Code:41017-2501
Practice Address - Country:US
Practice Address - Phone:859-331-4159
Practice Address - Fax:859-331-4163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-30
Last Update Date:2023-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY65936809Medicaid
OH9368861Medicare PIN
KY7048Medicare PIN
KY7047Medicare PIN