MEDICARE: ADVANCED PAIN MANAGEMENT SURGERY,INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1669500229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCED PAIN MANAGEMENT SURGERY,INC

Provider Business Mailing Address
First Line	:	PO BOX 1161
Second Line	:
City	:	COLUMBUS
State	:	IN
Zip	:	47202-1161
Country	:	US
Telephone Number	:	812-342-8300
Fax Number	:	812-342-8304

Provider Business Practice Location Address
First Line	:	4010 W GOELLER BLVD
Second Line	:	SUITE C
City	:	COLUMBUS
State	:	IN
Zip	:	47201-8892
Country	:	US
Telephone Number	:	812-342-8300
Fax Number	:	812-342-8304

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MRS. KATRINA B. WHITWORTH
Credential	:	RN,BSN,MHA
Telephone Number	:	812-342-8300

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	04/20/2008

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