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Organization

PAIN CARE INSTITUTE

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MS. TRACEY A EVERHAM (OFFICE MANAGER)
(215) 338-1811
Entity
Organization

Contact information

Practice address
6200 FRANKFORD AVE, PHILADELPHIA, PA 19135-3400
(215) 535-3980
(215) 535-5025
Mailing address
6200 FRANKFORD AVE, PHILADELPHIA, PA 19135-3400
(215) 535-3980
(215) 535-5025

Taxonomy

Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
MD045589L
PA

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
020429
HIGHMARK BLUE SHIELD
PA
01
0658614000
INDEPENDENCE BLUE CROSS
PA
01
258129
UNISON
PA
01
50082873
CAPITAL BLUE CROSS
PA
01
5541318
AETNA
PA
Enumeration date
05/19/2006
Last updated
12/15/2010
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