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NPI Code Detail

MEDICARE: ADVANCED INTERVENTIONAL PAIN CENTER LLC

MEDICARE: ADVANCED INTERVENTIONAL PAIN CENTER LLC
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
1208VP0014XInterventional Pain Medicine Physician

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1821014580
Entity Type Code : Organization
Provider Name (Legal Business Name) : ADVANCED INTERVENTIONAL PAIN CENTER LLC
Provider Business Mailing Address
First Line : 2001 N GRANVILLE AVE
Second Line :
City : MUNCIE
State : IN
Zip : 47303-2110
Country : US
Telephone Number : 765-284-0493
Fax Number : 765-284-2434
Provider Business Practice Location Address
First Line : 613 W LINCOLN RD STE A
Second Line :
City : KOKOMO
State : IN
Zip : 46902-3460
Country : US
Telephone Number : 765-319-3522
Fax Number : 765-450-6161
Authorized Official
Title or Position : CEO
Name : PATTANAM DORAI SRINIVASAN
Credential : MD
Telephone Number : 765-891-0721
Provider Enumeration Date : 07/14/2006
Last Update Date : 07/04/2020

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Directions to “ADVANCED INTERVENTIONAL PAIN CENTER LLC ” Practice Location

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