Healthcare Provider Details

I. General information

NPI: 1023353729
Provider Name (Legal Business Name): FMMG PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/06/2012
Last Update Date: 12/06/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

IV. Provider business mailing address

1850 STATE ST
NEW ALBANY IN
47150-4990
US

V. Phone/Fax

Practice location:
  • Phone: 812-949-5790
  • Fax:
Mailing address:
  • Phone: 812-949-5790
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number State

VIII. Authorized Official

Name: JOYCE WHISTINE
Title or Position: VP OF OPERATIONS
Credential:
Phone: 812-944-7701