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General NPI Number Information
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NPI Number | 1245021369
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Entity Type | Organization
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Legal Business Name | RESTORATIVE PAIN INSTITUTE
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Dates
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Enumeration Date | 05/16/2025
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Last Update Date | 05/16/2025
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Provider Practice Location Address
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Address Line | 4201 SPRINGHURST BLVD STE 102
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City | LOUISVILLE
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State | KY
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Zip | 40241-6156
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Country | US
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Telephone | 502-515-6090
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Fax |
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Provider Business Mailing Address
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Address Line | 4201 SPRINGHURST BLVD STE 102
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City | LOUISVILLE
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State | KY
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Zip | 40241-6156
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TIMOTHY JAMES BEACHAM
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Credential |
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Telephone | 502-515-4901
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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