Basic Information
| Provider Information | |||||||||
| NPI: | 1184892234 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCED PAIN MANAGEMENT OF CENTRAL INDIANA, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 3052 | ||||||||
| Address2: | |||||||||
| City: | INDIANAPOLIS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 462063052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3176149850 | ||||||||
| FaxNumber: | 8007310751 | ||||||||
| Practice Location | |||||||||
| Address1: | 10412 ALLISONVILLE RD | ||||||||
| Address2: | SUITE 100 | ||||||||
| City: | FISHERS | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460382052 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3175722240 | ||||||||
| FaxNumber: | 3175722235 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/12/2008 | ||||||||
| LastUpdateDate: | 08/29/2014 | ||||||||
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| AuthorizedOfficialLastName: | FRANIAK | ||||||||
| AuthorizedOfficialFirstName: | RANDALL | ||||||||
| AuthorizedOfficialMiddleName: | J | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER/PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 3175722240 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | 5004994A | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine | 208VP0000X | 50004994A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 200894510A | 05 | IN | MEDICAID |