Provider Demographics
NPI:1447517404
Name:INTEGRATED PAIN CARE INC
Entity type:Organization
Organization Name:INTEGRATED PAIN CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:GARY
Authorized Official - Middle Name:
Authorized Official - Last Name:MARTINOVSKY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:415-279-7393
Mailing Address - Street 1:3065 RICHMOND PKWY
Mailing Address - Street 2:SUITE 101
Mailing Address - City:RICHMOND
Mailing Address - State:CA
Mailing Address - Zip Code:94806-5719
Mailing Address - Country:US
Mailing Address - Phone:415-279-7393
Mailing Address - Fax:800-806-5602
Practice Address - Street 1:3065 RICHMOND PKWY
Practice Address - Street 2:SUITE 101
Practice Address - City:RICHMOND
Practice Address - State:CA
Practice Address - Zip Code:94806-5719
Practice Address - Country:US
Practice Address - Phone:415-279-7393
Practice Address - Fax:800-806-5602
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-16
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA77502207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA6675120001Medicare NSC