Healthcare Provider Details

I. General information

NPI: 1578800561
Provider Name (Legal Business Name): COMPLETE PAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2013
Last Update Date: 01/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10744 E US HIGHWAY 36
AVON IN
46123-7982
US

IV. Provider business mailing address

10744 E US HIGHWAY 36
AVON IN
46123-7982
US

V. Phone/Fax

Practice location:
  • Phone: 317-209-9811
  • Fax: 317-209-9812
Mailing address:
  • Phone: 317-209-9811
  • Fax: 317-209-9812

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SALLY TINCHER
Title or Position: OFFICE MANAGER
Credential:
Phone: 765-557-8541