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	174400000X	Specialist	E0476	AR

General Provider Information

NPI Number	:	1982672291
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL PAIN CONSULTANTS, PA

Provider Business Mailing Address
First Line	:	2215 WILDWOOD AVE
Second Line	:	STE 206
City	:	SHERWOOD
State	:	AR
Zip	:	72120-5089
Country	:	US
Telephone Number	:	501-833-0046
Fax Number	:	501-833-0096

Provider Business Practice Location Address
First Line	:	2215 WILDWOOD AVE
Second Line	:	STE 206
City	:	SHERWOOD
State	:	AR
Zip	:	72120-5089
Country	:	US
Telephone Number	:	501-833-0046
Fax Number	:	501-833-0096

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. BRIAN THOMAS NICHOL
Credential	:	M.D.
Telephone Number	:	501-833-0046

Provider Enumeration Date	:	03/10/2006
Last Update Date	:	08/22/2020

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