MEDICARE: INTERVENTIONAL PAIN CENTER, PLLC

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	200100673	NC

General Provider Information

NPI Number	:	1790221612
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN CENTER, PLLC

Provider Business Mailing Address
First Line	:	PO BOX 931038
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	31193-1038
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	451 RUIN CREEK RD
Second Line	:	SUITE 103
City	:	HENDERSON
State	:	NC
Zip	:	27536-2878
Country	:	US
Telephone Number	:	252-438-3186
Fax Number	:	252-438-2602

Authorized Official
Title or Position	:	RCM MANAGER
Name	:	SHANEKA TINCH
Credential	:
Telephone Number	:	469-458-9222

Provider Enumeration Date	:	01/17/2017
Last Update Date	:	12/08/2025

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