PROVIDENCE PAIN MANAGEMENT CENTER, P.A. (NPI# 1285121749) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1285121749 |
| Entity Type | Organization |
| Organization Name | PROVIDENCE PAIN MANAGEMENT CENTER, P.A. |
| Other Organization Name | INNOVATIVE LABORATORIES |
| Practice Address |
6911 Laurel Bowie Rd Ste 212b Bowie MD 20715-1712 |
| Practice Telephone | 3017559500 |
| Practice Fax Number | 3017476017 |
| Mailing Telephone | 3017559500 |
| Mailing Fax Number | 3017476017 |
| Enumeration Date | 2018-04-19 |
| Last Update Date | 2019-08-13 |
| Authorized Official Name | JOSEPH MAXWELL OPPONG (CEO) |
| Authorized Official Telephone | 3017509500 |
| Authorized Official Credential | M.D. |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 291U00000X | Clinical Medical Laboratory | 21D2142104 | MD | Laboratories |
| Other Name | Type Code |
|---|---|
| Innovative Laboratories | Doing Business As Name - Organization |
| Address | Telephone Number | Fax Number |
|---|---|---|
| 201 Pine Bluff Rd Ste 1, Salisbury, MD 218017163 | 4106482000 | 4109468360 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1932506284 | Providence Pain Management Center, P.a. | Anesthesiology | 6911 Laurel Bowie Rd, Suite 212, Bowie, MD 20715-1712 | 2014-12-02 |
| Street Address |
6911 LAUREL BOWIE RD STE 212B |
| City | BOWIE |
| State | MD |
| Zip Code | 20715-1712 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104304757 | Aynia V Dorsey | Occupational Therapist | 6915 Laurel Bowie Rd Ste 205b, Bowie, MD 20715 | 2018-08-04 |
| 1558852988 | Dmv Foot and Ankle Center | Podiatrist | 15480 Annapolis Rd Ste 202-437, Bowie, MD 20715 | 2018-05-22 |
| 1861918435 | Ryan Leigh Brown | Psychologist | 3231 Superior Lane, Suite, A6, Bowie, MD 20715 | 2017-08-16 |
| 1073060430 | Chinwendu Ezeoru | Nurse Practitioner | 13004 Viewpoint Ln, Bowie, MD 20715 | 2016-09-02 |
| 1386094977 | Harris Teeter LLC | Durable Medical Equipment & Medical Supplies | 15501 Annapolis Rd, Suite 400, Bowie, MD 20715 | 2016-06-15 |
| 1083003164 | Megan Elizabeth Cooper | Social Worker | 2812 Bosworth Ln, Bowie, MD 20715 | 2015-01-13 |
| 1467856740 | Nathan-todd Consulting | Community/Behavioral Health | 3231 Superior Court Lane,# A5, Bowie, MD 20715 | 2014-10-15 |
| 1841534468 | Varsity Professional Rehabilitation and Staffing, LLC | Physical Therapist | 14000 Jericho Park Road, Bowie, MD 20715 | 2012-11-20 |
| 1013269893 | Felix Chukwudi Ohams | Registered Nurse | 7613 Old Chapel Dr, Bowie, MD 20715 | 2012-10-04 |
| 1720336464 | Tara Marie Hatfield | Physical Therapist | 100 Whitemarsh Park Drive, Bowie, MD 20715 | 2012-08-28 |
| Find all providers in zip 20715 | ||||
| Taxonomy Code | 291U00000X |
| Grouping | Laboratories |
| Classification | Clinical Medical Laboratory |
| (1) A clinical laboratory is a facility for the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, human beings. These examinations also include procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Facilities only collecting or preparing specimens (or both) or only serving as a mailing service and not performing testing are not considered clinical laboratories. (2) Any facility that examines materials from the human body for purposes of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of, the health of human beings. Typical divisions of a clinical laboratory include hematology, cytology, bacteriology, histology, biochemistry, medical toxicology, and serology. |
| Notes: Source: (1) Code of Federal Regulations #42, Public Health, Section 493.2. (2) ) Lexikon: Dictionary of Health Care Terms, Organizations and Acronyms for the Era of Reform, The Joint Commission on Accreditation of Healthcare Organizations, Oakbrook Terrace, Illinois: 1994, p. 186. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1366539595 | Annapath, Inc | Clinical Medical Laboratory | 4801 Telsa Drive, Suite H, Bowie, MD 20715-4327 | 2006-10-09 |
| 1447361225 | Ajay Sonogram,inc | Clinical Medical Laboratory | 12410 Poplar View Dr, Bowie, MD 20720-3303 | 2006-08-31 |
| 1730745290 | Outreach Recovery II, LLC | Clinical Medical Laboratory | 4201 Northview Dr Ste 104, Bowie, MD 20716-2604 | 2019-05-10 |
| 1073059515 | Lifestream Health Center | Clinical Medical Laboratory | 4000 Mitchellville Rd, Suite B322, Bowie, MD 20716-3104 | 2017-01-09 |
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| 1669095600 | Aeon Technologies, LLC | Clinical Medical Laboratory | 1 Technology Dr Ste 1600, Frostburg, MD 21532-2499 | 2020-05-26 |
| 1093336349 | Personalized Medicine Care Diagnostics LLC | Clinical Medical Laboratory | 20271 Goldenrod Ln Fl 2, Germantown, MD 20876-4064 | 2020-04-28 |
| 1164058525 | Parj Diagnostics LLC | Clinical Medical Laboratory | 10019 Reisterstown Rd Ste 211, Owings Mills, MD 21117-3902 | 2020-03-18 |
| 1437785896 | Meta Science LLC | Clinical Medical Laboratory | 10019 Reisterstown Rd Ste 213, Owings Mills, MD 21117-3902 | 2020-03-18 |
| 1154956159 | Almat Bio Solutions LLC | Clinical Medical Laboratory | 10019 Reisterstown Rd Ste 212, Owings Mills, MD 21117-3902 | 2020-03-10 |
| 1689206112 | Applied Immunogenetics Laboratory | Clinical Medical Laboratory | 11419 Cronridge Dr Ste 17, Owings Mills, MD 21117-6283 | 2020-02-12 |
| 1033749296 | Mprobe Inc | Clinical Medical Laboratory | 9600 Medical Center Dr Ste 300, Rockville, MD 20850-6329 | 2020-01-16 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.