Basic Information
| Provider Information | |||||||||
| NPI: | 1609333723 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTERS FOR PAIN CONTROL, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2500 CALUMET AVE STE E | ||||||||
| Address2: | |||||||||
| City: | VALPARAISO | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463833735 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194767246 | ||||||||
| FaxNumber: | 8448611079 | ||||||||
| Practice Location | |||||||||
| Address1: | 1928 45TH ST | ||||||||
| Address2: | |||||||||
| City: | MUNSTER | ||||||||
| State: | IN | ||||||||
| PostalCode: | 463213917 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2194767246 | ||||||||
| FaxNumber: | 2194761713 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/25/2019 | ||||||||
| LastUpdateDate: | 02/11/2021 | ||||||||
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| AuthorizedOfficialLastName: | PURANIK | ||||||||
| AuthorizedOfficialFirstName: | UJWALA | ||||||||
| AuthorizedOfficialMiddleName: | S | ||||||||
| AuthorizedOfficialTitleorPosition: | ADMINISTRATOR | ||||||||
| AuthorizedOfficialTelephone: | 2194767246 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | Y | ||||||||
| ParentOrganizationLBN: | CENTERS FOR PAIN CONTROL, INC | ||||||||
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| NPICertificationDate: | 02/11/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 2085R0202X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Diagnostic Radiology | 2085R0204X | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Radiology | Vascular & Interventional Radiology | 261QM1300X | N | Ambulatory Health Care Facilities | Clinic/Center | Multi-Specialty | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 208VP0000X | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.