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General NPI Number Information
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NPI Number | 1629241906
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Entity Type | Organization
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Legal Business Name | PAIN CLINIC LLC
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Dates
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Enumeration Date | 04/08/2008
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Last Update Date | 04/08/2008
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Provider Practice Location Address
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Address Line | 2180 NORCOR AVE SUITE B
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City | CORALVILLE
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State | IA
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Zip | 52241-9748
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Country | US
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Telephone | 319-330-4392
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Fax |
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Provider Business Mailing Address
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Address Line | 2180 NORCOR AVE SUITE B
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City | CORALVILLE
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State | IA
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Zip | 52241-9748
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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 | DR. GENE S GESSNER
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Credential | MD
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Telephone | 319-330-4392
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | 28333
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License Number State | IA
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