=====================================================
General NPI Number Information
=====================================================
NPI Number | 1568339752
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PAIN MANAGEMENT INTERVENTIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/21/2025
-----------------------------------------------------
Last Update Date | 10/21/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1101 S COLLEGE RD STE 402
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70503-3038
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-849-7675
-----------------------------------------------------
Fax | 877-813-3598
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 80507
-----------------------------------------------------
City | LAFAYETTE
-----------------------------------------------------
State | LA
-----------------------------------------------------
Zip | 70598-0507
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 337-849-7675
-----------------------------------------------------
Fax | 877-813-3598
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRACTICE MANAGER
-----------------------------------------------------
Name | DR. JOHN MARTIN
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 337-849-7675
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------