Provider Demographics
NPI:1548449192
Name:PAIN AND WELLNESS CENTER
Entity type:Organization
Organization Name:PAIN AND WELLNESS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DENISE
Authorized Official - Middle Name:L
Authorized Official - Last Name:THIBODEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:978-826-7230
Mailing Address - Street 1:10 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:PEABODY
Mailing Address - State:MA
Mailing Address - Zip Code:01960-7900
Mailing Address - Country:US
Mailing Address - Phone:978-826-7230
Mailing Address - Fax:978-826-1045
Practice Address - Street 1:10 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:PEABODY
Practice Address - State:MA
Practice Address - Zip Code:01960-7900
Practice Address - Country:US
Practice Address - Phone:978-826-7230
Practice Address - Fax:978-826-1045
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA17659261QP2000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA0486537OtherAETNA
MAM17785OtherBLUE CROSS GROUP NUMBER
MAM20326OtherGROUP NUMBER
MA0012153OtherNEIGHBORHOOD HEALTH PLAN
MA277396OtherHARVARD PILGRIM GROUP #
MA0012153OtherNEIGHBORHOOD HEALTH PLAN