Basic Information
| Provider Information | |||||||||
| NPI: | 1093957789 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTERVENTIONAL PAIN CARE LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 60 BUSINESS PARK DR STE A | ||||||||
| Address2: | |||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633792828 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6367289460 | ||||||||
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| Practice Location | |||||||||
| Address1: | 60 BUSINESS PARK DR | ||||||||
| Address2: | STE A | ||||||||
| City: | TROY | ||||||||
| State: | MO | ||||||||
| PostalCode: | 633792827 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6367289460 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/27/2009 | ||||||||
| LastUpdateDate: | 11/05/2018 | ||||||||
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| AuthorizedOfficialLastName: | KUNHIRAMAN | ||||||||
| AuthorizedOfficialFirstName: | SAVITHA | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6363339723 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MRS. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 332B00000X | 2004011002 | MO | N | Suppliers | Durable Medical Equipment & Medical Supplies | 261QP3300X | Y | Ambulatory Health Care Facilities | Clinic/Center | Pain |
No ID Information.