Provider Demographics
NPI:1255352241
Name:WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC
Entity type:Organization
Organization Name:WARREN PAIN CLINIC AND ACUPUNCTURE CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MOHAMED
Authorized Official - Middle Name:
Authorized Official - Last Name:KOURTU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:814-726-7365
Mailing Address - Street 1:908 NIAGARA FALLS BLVD
Mailing Address - Street 2:SUITE 208
Mailing Address - City:NORTH TONAWANDA
Mailing Address - State:NY
Mailing Address - Zip Code:14120-2019
Mailing Address - Country:US
Mailing Address - Phone:716-692-2160
Mailing Address - Fax:716-213-0935
Practice Address - Street 1:103 WEST ST. CLAIR STREET
Practice Address - Street 2:SUITE 2C
Practice Address - City:WARREN
Practice Address - State:PA
Practice Address - Zip Code:16365-2188
Practice Address - Country:US
Practice Address - Phone:814-726-7365
Practice Address - Fax:814-726-7369
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-22
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAMD049485L207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty