Healthcare Provider Details

I. General information

NPI: 1649228362
Provider Name (Legal Business Name): INTERVENTIONAL PAIN CARE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/05/2006
Last Update Date: 10/27/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5501 W BETHEL AVE
MUNCIE IN
47304-8513
US

IV. Provider business mailing address

PO BOX 6069 DEPT 171
INDIANAPOLIS IN
46206-6069
US

V. Phone/Fax

Practice location:
  • Phone: 765-741-3111
  • Fax: 765-747-3310
Mailing address:
  • Phone: 317-567-2180
  • Fax: 317-567-2191

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: NEAL E COLEMAN
Title or Position: PRESIDENT
Credential: MD
Phone: 765-741-3111