Provider Demographics
NPI:1023346194
Name:ST. JOHN NEUMANNS INTERGRATED PAIN MANAGEMENT
Entity type:Organization
Organization Name:ST. JOHN NEUMANNS INTERGRATED PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:MR
Authorized Official - First Name:PABLO
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERCED
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:606-666-4011
Mailing Address - Street 1:1389 HIGHWAY 15 N.
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:KY
Mailing Address - Zip Code:41339
Mailing Address - Country:US
Mailing Address - Phone:606-666-4011
Mailing Address - Fax:606-666-5801
Practice Address - Street 1:1389 HIGHWAY 15 N.
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:KY
Practice Address - Zip Code:41339
Practice Address - Country:US
Practice Address - Phone:606-666-4011
Practice Address - Fax:606-666-5801
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-11-30
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain