Basic Information
| Provider Information | |||||||||
| NPI: | 1487866075 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | BLUFFS PAIN MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 201 RIDGE ST | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 515034643 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123225565 | ||||||||
| FaxNumber: | 7123225566 | ||||||||
| Practice Location | |||||||||
| Address1: | 201 RIDGE STREET | ||||||||
| Address2: | SUITE 102 | ||||||||
| City: | COUNCIL BLUFFS | ||||||||
| State: | IA | ||||||||
| PostalCode: | 51503 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7123964359 | ||||||||
| FaxNumber: | 7123964358 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/04/2007 | ||||||||
| LastUpdateDate: | 11/20/2015 | ||||||||
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| AuthorizedOfficialLastName: | SMITH | ||||||||
| AuthorizedOfficialFirstName: | PAM | ||||||||
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| AuthorizedOfficialTitleorPosition: | OFFICE MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 7123225565 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.