MEDICARE: IMPERIAL VALLEY PAIN & WELLNESS MANAGEMENT INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy
1	261QP2300X	Primary Care Clinic/Center
2	324500000X	Substance Abuse Rehabilitation Facility
3	261QP3300X	Pain Clinic/Center
4	2081P2900X	Pain Medicine (Physical Medicine & Rehabilitation) Physician

General Provider Information

NPI Number	:	1265392674
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL VALLEY PAIN & WELLNESS MANAGEMENT INC.

Provider Business Mailing Address
First Line	:	485 BROADWAY AVE STE F
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2451
Country	:	US
Telephone Number	:	760-970-4064
Fax Number	:	619-304-1580

Provider Business Practice Location Address
First Line	:	485 BROADWAY AVE STE F
Second Line	:
City	:	EL CENTRO
State	:	CA
Zip	:	92243-2451
Country	:	US
Telephone Number	:	760-970-4064
Fax Number	:	619-304-1580

Authorized Official
Title or Position	:	OWNER
Name	:	SHARRON LOTUS THOMPSON
Credential	:	MD
Telephone Number	:	760-970-4064

Provider Enumeration Date	:	11/17/2025
Last Update Date	:	12/29/2025

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