Healthcare Provider Details

I. General information

NPI: 1043322001
Provider Name (Legal Business Name): JOLIET PAIN CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/31/2006
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 ONEIDA ST #304
JOLIET IL
60435
US

IV. Provider business mailing address

8255 LEMONT RD STE 200
DARIEN IL
60561-1800
US

V. Phone/Fax

Practice location:
  • Phone: 815-730-6800
  • Fax: 815-730-6868
Mailing address:
  • Phone: 630-598-2624
  • Fax: 630-598-2674

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code2084N0400X
TaxonomyNeurology Physician
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 7
Primary TaxonomyY
Taxonomy Code2084S0012X
TaxonomySleep Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT RICHARD ANDERSON
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 630-598-2600