Healthcare Provider Details

I. General information

NPI: 1144180290
Provider Name (Legal Business Name): PAIN MANAGEMENT INTERVENTIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/12/2025
Last Update Date: 11/12/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1101 S COLLEGE RD STE 402
LAFAYETTE LA
70503-3038
US

IV. Provider business mailing address

PO BOX 80507
LAFAYETTE LA
70598-0507
US

V. Phone/Fax

Practice location:
  • Phone: 337-849-7675
  • Fax: 877-813-3598
Mailing address:
  • Phone: 337-849-7675
  • Fax: 877-813-3598

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: DR. JOHN MARTIN
Title or Position: PROVIDER/OWNER
Credential: MD
Phone: 337-849-7675