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Organization
PAIN AND AGING MANAGEMENT LLC
Active
Organization
PAIN AND AGING MANAGEMENT LLC
Active
Other names
Wellspring Pain Solutions
Organization subpart
No
Provider details
NPI number
Authorized official
SANDFORD MATTHEW SCHOCKET (CEO)
(512) 584-8404
Entity
Organization
Contact information
Practice address
2400 NORTHPARK DR STE 20, COLUMBUS, IN 47203-4467
(812) 376-0700
(812) 376-8625
Mailing address
7951 SHOAL CREEK BLVD STE 300, AUSTIN, TX 78757-7582
(512) 584-8404
(812) 376-8625
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208100000X
Physical Medicine & Rehabilitation Physician
—
—
208VP0000X
Pain Medicine Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
363A00000X
Physician Assistant
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000366888
ANTHEM
—
05
—
201032950A
—
IN
01
—
226700
MEDICARE
IN
05
—
300058095
—
IN
05
—
300058096
—
IN
05
—
300058102
—
IN
05
—
300058106
—
IN
Enumeration date
10/20/2006
Last updated
05/17/2024
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