Organization
TRI-STATE PAIN INSTITUTE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JOSEPH A THOMAS (SUPERVISOR)
(814) 833-1147
Entity
Organization
Contact information
Practice address
2374 VILLAGE COMMON DR, SUITE 100, ERIE, PA 16506-7201
(814) 833-7246
(814) 833-1147
Mailing address
2374 VILLAGE COMMON DR, SUITE 100, ERIE, PA 16506-7201
(814) 833-7246
(814) 833-1147
Taxonomy
Speciality
Code
Description
License number
State
2081P2900X
Pain Medicine (Physical Medicine & Rehabilitation) Physician
MD045797L
PA
208VP0014X
Interventional Pain Medicine Physician
Primary
MD045797L
PA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0012660260005
—
PA
05
—
0717424
—
OH
01
—
273480
BLUE SHIELD
PA
Enumeration date
02/22/2008
Last updated
09/11/2020
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