Healthcare Provider Details

I. General information

NPI: 1578821740
Provider Name (Legal Business Name): OHIO VALLEY PAIN INTERVENTION LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/25/2012
Last Update Date: 07/07/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8211 W STATE ROUTE 66 NEWBURGH
NEWBURGH IN
47630-2534
US

IV. Provider business mailing address

8211 W STATE ROUTE 66 NEWBURGH
NEWBURGH IN
47630-2534
US

V. Phone/Fax

Practice location:
  • Phone: 812-858-1008
  • Fax: 812-858-1001
Mailing address:
  • Phone: 812-858-1008
  • Fax: 812-858-1001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number StateIN
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number05008961A
License Number StateIN
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71005174A
License Number StateIN

VIII. Authorized Official

Name: SHAUN TYMCHAK
Title or Position: OWNER
Credential: DC
Phone: 812-858-1008