Provider Demographics
NPI:1043926686
Name:HARBOR INTERVENTIONAL PAIN CENTER, LLC
Entity type:Organization
Organization Name:HARBOR INTERVENTIONAL PAIN CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRINCIPLE
Authorized Official - Prefix:
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:LACY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:603-294-9190
Mailing Address - Street 1:291 SHATTUCK WAY STE 2
Mailing Address - Street 2:
Mailing Address - City:NEWINGTON
Mailing Address - State:NH
Mailing Address - Zip Code:03801-7869
Mailing Address - Country:US
Mailing Address - Phone:603-294-9190
Mailing Address - Fax:603-380-7967
Practice Address - Street 1:291 SHATTUCK WAY STE 2
Practice Address - Street 2:
Practice Address - City:NEWINGTON
Practice Address - State:NH
Practice Address - Zip Code:03801-7869
Practice Address - Country:US
Practice Address - Phone:603-294-9190
Practice Address - Fax:603-380-7967
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-26
Last Update Date:2025-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty