1346399268 NPI number — CENTER FOR PAIN CONTROL, P.C.

Table of content: DR. ANDREA PATRICE WATKINS MD, MPH (NPI 1801025515)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346399268 NPI number — CENTER FOR PAIN CONTROL, P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR PAIN CONTROL, P.C.
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:
1346399268
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1800 HOLLISTER DR
Provider Second Line Business Mailing Address:
SUITE 206
Provider Business Mailing Address City Name:
LIBERTYVILLE
Provider Business Mailing Address State Name:
IL
Provider Business Mailing Address Postal Code:
60048-5263
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
847-549-1609
Provider Business Mailing Address Fax Number:
847-549-1646

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1800 HOLLISTER DR
Provider Second Line Business Practice Location Address:
SUITE 206
Provider Business Practice Location Address City Name:
LIBERTYVILLE
Provider Business Practice Location Address State Name:
IL
Provider Business Practice Location Address Postal Code:
60048-5263
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
847-549-1609
Provider Business Practice Location Address Fax Number:
847-549-1646
Provider Enumeration Date:
01/09/2007

Additional Information

Authorized Official

Authorized Official Last Name:
IRWIN
Authorized Official First Name:
BRUCE
Authorized Official Middle Name:
W.
Authorized Official Title or Position:
MEDICAL DIRECTOR
Authorized Official Telephone Number:
847-549-1609

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  60008451 , registered in the state of IL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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