Healthcare Provider Details

I. General information

NPI: 1457851578
Provider Name (Legal Business Name): PAIN RELIEF CENTERS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2018
Last Update Date: 02/18/2025
Certification Date: 02/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5129 DIXIE HWY STE 201
LOUISVILLE KY
40216-1727
US

IV. Provider business mailing address

5129 DIXIE HWY STE 201
LOUISVILLE KY
40216-1727
US

V. Phone/Fax

Practice location:
  • Phone: 502-430-6223
  • Fax: 502-792-7291
Mailing address:
  • Phone: 502-430-6223
  • Fax: 502-369-5229

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ROBERT KLICKOVICH
Title or Position: OWNER
Credential: MD
Phone: 502-430-6223