# PAIN CENTER OF WYOMING VALLEY, LLC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1629409578
- **Authorized official:** AMANDA RICCA (CEO)
- **Authorized official phone:** (570) 270-5700

## Contact information

- **Practice address:** 142 MUNDY ST, WILKES BARRE, PA 18702-6875
- **Practice address phone:** (570) 270-5712
- **Practice address fax:** (570) 270-2015
- **Mailing address:** 1177 HIGHWAY 315 BLVD, DOLPHIN PLAZA, WILKES BARRE, PA 18702-6928
- **Mailing address phone:** (570) 270-5712
- **Mailing address fax:** (570) 270-5719

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QA1903X | Ambulatory Surgical Clinic/Center | 23881501 | PA | Yes |

## Other

- **Enumeration date:** 12/03/2013
- **Last updated:** 05/04/2023