Basic Information
| Provider Information | |||||||||
| NPI: | 1952771974 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | ADVANCE PAIN RELIEF OF INDIANA INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2976 N SCATTERFIELD RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460121587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656438781 | ||||||||
| FaxNumber: | 7656220126 | ||||||||
| Practice Location | |||||||||
| Address1: | 2976 N SCATTERFIELD RD STE 150 | ||||||||
| Address2: | |||||||||
| City: | ANDERSON | ||||||||
| State: | IN | ||||||||
| PostalCode: | 460121587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7656438781 | ||||||||
| FaxNumber: | 7656220126 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2015 | ||||||||
| LastUpdateDate: | 10/02/2015 | ||||||||
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| AuthorizedOfficialLastName: | LUSHINSKY | ||||||||
| AuthorizedOfficialFirstName: | DAVID | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 3173857620 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | DC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 111N00000X | 08001691A | IN | N | 193200000X MULTI-SPECIALTY GROUP | Chiropractic Providers | Chiropractor | 207L00000X | 01071236A | IN | N | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | 225100000X | 05008752A | IN | N | 193200000X MULTI-SPECIALTY GROUP | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist | 332B00000X | N | Suppliers | Durable Medical Equipment & Medical Supplies | 363L00000X | 28173385A | IN | N | 193200000X MULTI-SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | 208VP0014X | 01071236A | IN | Y | 193200000X MULTI-SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.