MODERN PAIN & SPINE PC (NPI# 1821695081) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1821695081 |
| Entity Type | Organization |
| Organization Name | MODERN PAIN & SPINE PC |
| Practice Address |
1540 Juan Tabo Blvd Ne Ste A Albuquerque NM 87112-4460 |
| Practice Telephone | 5053190231 |
| Mailing Telephone | 5053190231 |
| Enumeration Date | 2020-10-01 |
| Last Update Date | 2020-10-01 |
| Authorized Official Name | DR. ATHANASIOS KOSTANDINOS MANOLE (MEDICAL DIRECTOR) |
| Authorized Official Telephone | 5053190231 |
| Authorized Official Credential | MD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 2083P0901X |
Preventive Medicine Specialization: Public Health & General Preventive Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 2083X0100X |
Preventive Medicine Specialization: Occupational Medicine |
Allopathic & Osteopathic Physicians | ||
| Y | 208VP0014X |
Pain Medicine Specialization: Interventional Pain Medicine |
Allopathic & Osteopathic Physicians |
| Street Address |
1540 JUAN TABO BLVD NE STE A |
| City | ALBUQUERQUE |
| State | NM |
| Zip Code | 87112-4460 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1780002220 | Athanasios Kostandinos Manole | Preventive Medicine | 1540 Juan Tabo Blvd Ne Ste A, Albuquerque, NM 87112-4460 | 2014-04-02 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1356999411 | Lynn Eileen Riley | Counselor | 10205 Stovall Pl Ne, Albuquerque, NM 87112 | 2019-08-30 |
| 1548818222 | Cindy D Montoya | Technician | 11405 Snow Heights Blvd Ne, Albuquerque, NM 87112 | 2019-08-27 |
| 1194387449 | Karen Sue Stockham | Counselor | 9024 Aspen Ave Ne, Albuquerque, NM 87112 | 2019-07-07 |
| 1316416837 | New Beginning Counseling Services Inc | Counselor | 2617 Juan Tabo Blvd Ne Unit A/d, Albuquerque, NM 87112 | 2018-11-14 |
| 1306365929 | Calyx Institute LLC | Social Worker | 10701 Lomas Blvd Ne, Ste. 101, Albuquerque, NM 87112 | 2017-09-14 |
| 1811411135 | Annette Romero | Case Manager/Care Coordinator | 9741 Candelaria, Albuquerque, NM 87112 | 2017-07-28 |
| 1851814784 | Ally Renee Funkhouser Dye | Pediatrics | 2130 Eubank Blvd Ne, Albuquerque, NM 87112 | 2017-07-23 |
| 1508303140 | Makena Bailey Nash | Behavior Technician | 12801 Indian School Ne Apt 508, Albuquerque, NM 87112 | 2017-01-20 |
| 1477978906 | Albert R Toya | Massage Therapist | 2601 Wyoming Blvd N.e. Room 115-c, Albuquerque, NM 87112 | 2014-02-20 |
| 1184918104 | Jennifer E Chavez | Counselor | 1505 Marron Circle Ne, Albuquerque, NM 87112 | 2011-06-07 |
| Find all providers in zip 87112 | ||||
| Taxonomy Code | 208VP0014X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Pain Medicine |
| Specialization | Interventional Pain Medicine |
| Interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104086859 | Brian Starr | Pain Medicine | 900 Camino De Salud, Albuquerque, NM 87131-0001 | 2008-06-16 |
| 1891903753 | Southwest Interventional Pain Specialists, PC | Pain Medicine | 4700 Jefferson Ne, Suite 700, Albuquerque, NM 87109-2132 | 2007-05-21 |
| 1326330739 | Timothy E. Hansen, D.o., P.a. | Pain Medicine | 3860 Masthead St Ne, Albuquerque, NM 87109-4479 | 2011-05-04 |
| 1205014693 | Pain Solutions LLC | Pain Medicine | 8080 Academy Rd Ne, Suite A, Albuquerque, NM 87111-1159 | 2008-02-07 |
| 1427104157 | Interventional Pain Specialists of New Mexico, P.a. | Pain Medicine | 4824 Mcmahon Blvd Nw, Suite 119, Albuquerque, NM 87114-5412 | 2007-01-26 |
| 1922190040 | Charles F Pace | Pain Medicine | 4824 Mcmahon Blvd Nw, Suite 119, Albuquerque, NM 87114-5412 | 2006-09-28 |
| 1669495834 | Craig Stephen Nairn | Pain Medicine | 8080 Academy Rd Ne, Suite A, Albuquerque, NM 87111-1159 | 2006-07-26 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1790002830 | Jose Luis Ramirez | Pain Medicine | 780 S Walnut St Bldg 3, Las Cruces, NM 88001-1425 | 2010-04-29 |
| 1396930152 | Carlsbad Spine Pain Sports Medicine PC | Pain Medicine | 2319 W Pierce St, Carlsbad, NM 88220-3515 | 2007-09-13 |
| 1851432835 | Jonas R. Skardis | Pain Medicine | 460 Saint Michaels Dr Ste 200, Santa Fe, NM 87505-7686 | 2007-02-10 |
| 1598939555 | John A Flores Md LLC | Pain Medicine | 2902 Hillrise Dr, Las Cruces, NM 88011-4702 | 2008-04-21 |
| 1679535298 | Thaddeus Alexas Ray | Pain Medicine | 2500 Farmington Ave, Farmington, NM 87401-6002 | 2006-04-06 |
| City | ALBUQUERQUE |
| Zip Code | 87112 |
Please comment or provide details below to improve the information on MODERN PAIN & SPINE PC.
| 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.