Healthcare Provider Details

I. General information

NPI: 1124440771
Provider Name (Legal Business Name): CENTERS FOR PAIN CONTROL INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/16/2014
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN ST
HOBART IN
46342-4439
US

IV. Provider business mailing address

2500 CALUMET AVE STE E
VALPARAISO IN
46383-3735
US

V. Phone/Fax

Practice location:
  • Phone: 219-476-7246
  • Fax: 219-476-1713
Mailing address:
  • Phone: 219-476-7246
  • Fax: 844-867-7131

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2085R0202X
TaxonomyDiagnostic Radiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2085R0204X
TaxonomyVascular & Interventional Radiology Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number1063580A
License Number StateIN

VIII. Authorized Official

Name: UJWALA PURANIK
Title or Position: ADMINISTRATOR
Credential:
Phone: 219-476-7246