MEDICARE: INTERVENTIONAL PAIN CONSULTANTS, PA

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	E-0476	AR

General Provider Information

NPI Number	:	1780743732
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	5106 MCCLANAHAN DR
Second Line	:	SUITE B
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7051
Country	:	US
Telephone Number	:	501-539-3383
Fax Number	:

Provider Business Practice Location Address
First Line	:	5106 MCCLANAHAN DR
Second Line	:	SUITE B
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72116-7051
Country	:	US
Telephone Number	:	501-539-3383
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	DR. BRIAN THOMAS NICHOL
Credential	:	M.D.
Telephone Number	:	501-539-3383

Provider Enumeration Date	:	12/06/2006
Last Update Date	:	08/22/2020

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