Provider Demographics
NPI:1992259576
Name:PURE PAIN PRACTICE LLC
Entity type:Organization
Organization Name:PURE PAIN PRACTICE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SUKHBIR
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:BHURJI
Authorized Official - Suffix:
Authorized Official - Credentials:PA-C
Authorized Official - Phone:585-713-9935
Mailing Address - Street 1:8895 CENTRE PARK DR
Mailing Address - Street 2:SUITE E
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-1966
Mailing Address - Country:US
Mailing Address - Phone:585-713-9935
Mailing Address - Fax:
Practice Address - Street 1:8895 CENTRE PARK DR
Practice Address - Street 2:SUITE E
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-1966
Practice Address - Country:US
Practice Address - Phone:585-713-9935
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-08-11
Last Update Date:2016-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0005282261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain