Providence Pain Management Center, P.a.

Primary specialty

Clinical Medical LaboratoryTaxonomy code 291U00000X

License

21D2142104 Issued in MD

Legal business name

PROVIDENCE PAIN MANAGEMENT CENTER, P.A.

Doing business as

Innovative Laboratories

Practice address

6911 Laurel Bowie Rd Ste 212B
Bowie, MD 20715-1712

Phone

(301) 755-9500

Fax

(301) 747-6017

NPI assigned

Apr 19, 2018

Last updated

Aug 13, 2019By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Joseph Maxwell Oppong, M.D.NPI 1174664007

Title

Ceo

Phone

(301) 750-9500

Specialties & licenses 1

Addresses

Other names 1

• Innovative Laboratories Doing business as

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

Tax ID family

Providence Pain Management Center PA2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Providence Pain Management Center, PA

  • Pain Medicine (Anesthesiology) Physician
  • Laurel, MD
  • NPI 1346708492
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

• Joseph Maxwell Oppong Jr., MD

  • Interventional Pain Medicine Physician
  • Bowie, MD
  • NPI 1174664007
  NPD (past) Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1524096000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1565654400000",
    "number": "1285121749",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD STE 212B",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207151712",
            "telephone_number": "301-755-9500",
            "fax_number": "301-747-6017"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6911 LAUREL BOWIE RD STE 212B",
            "city": "BOWIE",
            "state": "MD",
            "postal_code": "207151712",
            "telephone_number": "301-755-9500",
            "fax_number": "301-747-6017"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "201 Pine Bluff Rd Ste 1",
            "address_purpose": "LOCATION",
            "city": "Salisbury",
            "state": "MD",
            "postal_code": "218017163",
            "country_code": "US",
            "telephone_number": "410-648-2000",
            "fax_number": "410-946-8360",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "organization_name": "PROVIDENCE PAIN MANAGEMENT CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-04-19",
        "last_updated": "2019-08-13",
        "status": "A",
        "authorized_official_last_name": "OPPONG",
        "authorized_official_first_name": "JOSEPH",
        "authorized_official_middle_name": "MAXWELL",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "301-750-9500",
        "authorized_official_credential": "M.D."
    },
    "taxonomies": [
        {
            "code": "291U00000X",
            "taxonomy_group": "",
            "desc": "Clinical Medical Laboratory",
            "state": "MD",
            "license": "21D2142104",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "Innovative Laboratories",
            "code": "3",
            "type": "Doing Business As"
        }
    ]
}

• Proud Moments ABA
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• Randy W Prout
• Providence Anesthesia Associates, P.a.
• Providence Health Group LLC
• Providence Pain Management Center, P.a. (Innovative Pain Solutions Centers)
• Providence Wellness Healthcare LLC
• Proximity Health Care Services LLC
• PRP Dental LLC
• Prudent Behavioral and Wellness Health LLC

• Clinical Medical Laboratory in Bowie, MD
• Providers in Bowie, MD by specialty
• Clinical Medical Laboratory in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 13, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.