1023044146 NPI number — ADVANCED PAIN CENTERS LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1023044146 NPI number — ADVANCED PAIN CENTERS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PAIN CENTERS LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1023044146
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/06/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13 W US HIGHWAY 30
Provider Second Line Business Mailing Address:
SUITE 202
Provider Business Mailing Address City Name:
SCHERERVILLE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46375-2266
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
219-865-3819
Provider Business Mailing Address Fax Number:
219-865-5401

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5355 COMMERCE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CROWN POINT
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46307-5325
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
219-756-0600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
06/23/2006

Additional Information

Authorized Official

Authorized Official Last Name:
RAHMAN
Authorized Official First Name:
FAISAL
Authorized Official Middle Name:
M.
Authorized Official Title or Position:
CEO
Authorized Official Telephone Number:
219-865-3819

Provider Taxonomy Codes

  • Taxonomy code: 261QA1903X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2002497209 , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000098212 . This is a "BCBS" identifier , issued by the state of ( IL ) . This identifiers is of the category "OTHER".




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