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NPI Code Detail

MEDICARE: SOUTHSIDE PAIN RELIEF CENTER INC

MEDICARE: SOUTHSIDE PAIN RELIEF CENTER 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
1208VP0000XPain Medicine Physician

General Provider Information

NPI Number : 1710311170
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTHSIDE PAIN RELIEF CENTER INC
Provider Business Mailing Address
First Line : 5569 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2356
Country : US
Telephone Number : 708-717-5947
Fax Number : 708-576-8491
Provider Business Practice Location Address
First Line : 5569 W 95TH ST
Second Line :
City : OAK LAWN
State : IL
Zip : 60453-2356
Country : US
Telephone Number : 708-717-5947
Fax Number : 708-576-8491
Authorized Official
Title or Position : PRESIDENT
Name : DR. VALENTINO BOTTI
Credential : D.C.
Telephone Number : 708-717-5947
Provider Enumeration Date : 08/21/2013
Last Update Date : 08/21/2013

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Directions to “SOUTHSIDE PAIN RELIEF CENTER INC ” Practice Location

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