MEDICARE: INTERVENTIONAL PAIN CARE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	207L00000X	Anesthesiology Physician
2	363LF0000X	Family Nurse Practitioner
3	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1649228362
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN CARE, LLC

Provider Business Mailing Address
First Line	:	PO BOX 6069
Second Line	:	DEPT 171
City	:	INDIANAPOLIS
State	:	IN
Zip	:	46206-6069
Country	:	US
Telephone Number	:	317-567-2180
Fax Number	:	317-567-2191

Provider Business Practice Location Address
First Line	:	5501 W BETHEL AVE
Second Line	:
City	:	MUNCIE
State	:	IN
Zip	:	47304-8513
Country	:	US
Telephone Number	:	765-741-3111
Fax Number	:	765-747-3310

Authorized Official
Title or Position	:	PRESIDENT
Name	:	NEAL E COLEMAN
Credential	:	MD
Telephone Number	:	765-741-3111

Provider Enumeration Date	:	05/05/2006
Last Update Date	:	10/27/2008

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Directions to “INTERVENTIONAL PAIN CARE, LLC ” Practice Location

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