1184892234 NPI number — ADVANCED PAIN MANAGEMENT OF CENTRAL INDIANA, PC

Table of content: (NPI 1184892234)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184892234 NPI number — ADVANCED PAIN MANAGEMENT OF CENTRAL INDIANA, PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PAIN MANAGEMENT OF CENTRAL INDIANA, PC
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:
1184892234
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/29/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3052
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
INDIANAPOLIS
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
46206-3052
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
317-614-9850
Provider Business Mailing Address Fax Number:
800-731-0751

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10412 ALLISONVILLE RD
Provider Second Line Business Practice Location Address:
SUITE 100
Provider Business Practice Location Address City Name:
FISHERS
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46038-2052
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-572-2240
Provider Business Practice Location Address Fax Number:
317-572-2235
Provider Enumeration Date:
02/12/2008

Additional Information

Authorized Official

Authorized Official Last Name:
FRANIAK
Authorized Official First Name:
RANDALL
Authorized Official Middle Name:
J
Authorized Official Title or Position:
OWNER/PRESIDENT
Authorized Official Telephone Number:
317-572-2240

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  5004994A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X , with the licence number: 50004994A , registered in the state of IN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 200894510A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




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