Basic Information
| Provider Information | |||||||||
| NPI: | 1750614970 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHERN IOWA PAIN MANAGEMENT, PC | ||||||||
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| Mailing Information | |||||||||
| Address1: | PO BOX 2400 | ||||||||
| Address2: | |||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507042400 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192333044 | ||||||||
| FaxNumber: | 3192330722 | ||||||||
| Practice Location | |||||||||
| Address1: | 2710 SAINT FRANCIS DR | ||||||||
| Address2: | SUITE 202 | ||||||||
| City: | WATERLOO | ||||||||
| State: | IA | ||||||||
| PostalCode: | 507025619 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3192723323 | ||||||||
| FaxNumber: | 3192723320 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/08/2009 | ||||||||
| LastUpdateDate: | 09/08/2009 | ||||||||
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| AuthorizedOfficialLastName: | INAMDAR | ||||||||
| AuthorizedOfficialFirstName: | GAYATHRY | ||||||||
| AuthorizedOfficialMiddleName: | MURTHY | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3192333044 | ||||||||
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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 | 33957 | IA | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
No ID Information.