Healthcare Provider Details

I. General information

NPI: 1881759066
Provider Name (Legal Business Name): INTERVENTIONAL PAIN CONSULTANTS, P.S.C.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/27/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1401 HARRODSBURG RD SUITE C315
LEXINGTON KY
40504-3751
US

IV. Provider business mailing address

3320 TATES CREEK RD SUITE 204
LEXINGTON KY
40502-3400
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-2212
  • Fax:
Mailing address:
  • Phone: 859-268-1030
  • Fax: 859-269-4120

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: LUIS VASCELLO
Title or Position: PARTNER
Credential: M.D.
Phone: 859-268-1030