Pain Center of Wyoming Valley, LLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

License

23881501 Issued in PA

Legal business name

PAIN CENTER OF WYOMING VALLEY, LLC

Practice address

142 Mundy St
Wilkes Barre, PA 18702-6875

Phone

(570) 270-5712

Fax

(570) 270-2015

NPI assigned

Dec 3, 2013

Organization subpart

No

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

Authorized official

Name

Amanda Ricca

Title

Ceo

Phone

(570) 270-5700

Specialties & licenses 1

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in PA

Enrollment records 1

Listed as

Pain Center of Wyoming Valley LLCCCN 39C0001318

Medicare certification status

ActiveFrom the Provider of Services file

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

CLIA laboratory certificates

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

{
    "created_epoch": "1386028800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1683158400000",
    "number": "1629409578",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1177 HIGHWAY 315 BLVD",
            "address_2": "DOLPHIN PLAZA",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026928",
            "telephone_number": "570-270-5712",
            "fax_number": "570-270-5719"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "142 MUNDY ST",
            "city": "WILKES BARRE",
            "state": "PA",
            "postal_code": "187026875",
            "telephone_number": "570-270-5712",
            "fax_number": "570-270-2015"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN CENTER OF WYOMING VALLEY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-12-03",
        "last_updated": "2023-05-04",
        "certification_date": "2023-05-04",
        "status": "A",
        "authorized_official_last_name": "RICCA",
        "authorized_official_first_name": "AMANDA",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "570-270-5700"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "PA",
            "license": "23881501",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "1030398800001",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Heather Renae Paduck, P.A.-C
• Jamie L Padula, LPC
• Cynthia L Page
• Karlyn Paglia, M.D.
• Gina M Pahler, LPN
• Hassan Paknezhad
• Mark Peter Pallis, D.O.
• Vinit Pande, M.D.
• Dhwani Yogesh Pandya, M.D.
• Richael Jean Marquez Pantig, RN

• Ambulatory Surgical Clinic/Center in Wilkes Barre, PA
• Providers in Wilkes Barre, PA by specialty
• Ambulatory Surgical Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 4, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• 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.