# KEYSTONE PAIN CENTER LLC

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

## Provider details

- **NPI number:** 1902075617
- **Authorized official:** DASA SATYAM MD (PHYSICIAN)
- **Authorized official phone:** (570) 718-1307

## Contact information

- **Practice address:** 468 NORTHAMPTON ST, EDWARDSVILLE, PA 18704-4566
- **Practice address phone:** (570) 718-1307
- **Practice address fax:** (570) 718-1309
- **Mailing address:** 415 N MAIN ST, WILKES BARRE, PA 18702-4411
- **Mailing address phone:** (570) 208-5571
- **Mailing address fax:** (570) 208-5548

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207L00000X | Anesthesiology Physician | MD036737L | PA | — |
| 207LP2900X | Pain Medicine (Anesthesiology) Physician | MD036737L | PA | Yes |

## Other

- **Enumeration date:** 02/27/2008
- **Last updated:** 05/22/2008