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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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