Basic Information
| Provider Information | |||||||||
| NPI: | 1033531686 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTERS FOR PAIN CONTROL INC. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2211 ROOSEVELT RD | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 46383 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194767246 | ||||||||
| FaxNumber: | 2194761713 | ||||||||
| Practice Location | |||||||||
| Address1: | 8733 W 400 N | ||||||||
| Address2: | |||||||||
| City: | MICHIGAN CITY | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463609330 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194767246 | ||||||||
| FaxNumber: | 2194761713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/16/2014 | ||||||||
| LastUpdateDate: | 04/04/2014 | ||||||||
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| AuthorizedOfficialLastName: | PURANIK | ||||||||
| AuthorizedOfficialFirstName: | UJWALA | ||||||||
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| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2194767246 | ||||||||
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| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTERS FOR PAIN CONTROL INC. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 1063580A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.