Healthcare Provider Details

I. General information

NPI: 1740204262
Provider Name (Legal Business Name): CENTER FOR PAIN MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 11/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

980 CHESTER BLVD
RICHMOND IN
47374-2317
US

IV. Provider business mailing address

980 CHESTER BLVD
RICHMOND IN
47374-2317
US

V. Phone/Fax

Practice location:
  • Phone: 765-983-3410
  • Fax: 765-983-3045
Mailing address:
  • Phone: 765-983-3410
  • Fax: 765-983-3045

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: VISH BRAHMBHATT
Title or Position: PRESIDENT
Credential: MD
Phone: 765-983-3410