MIDWEST PAIN CLINIC INTERVENTIONAL LLC NPI 1548696446

NPI Information

NPI: 1548696446
Provider Name: MIDWEST PAIN CLINIC INTERVENTIONAL LLC
Classification: Clinic/Center - 261QP3300X
Entity Type: Organization

Specialization: Pain

CLIA Number: 15D2001084

Address:
350 COMMERCE SQ
MICHIGAN CITY, IN
ZIP 46360
Phone: (219) 872-9158
Get Directions

MIDWEST PAIN CLINIC INTERVENTIONAL LLC is a pain clinic center in Michigan City, IN. MIDWEST PAIN CLINIC INTERVENTIONAL LLC NPI is 1548696446. The provider is registered as an organization entity type.

The provider's business location address is:

350 COMMERCE SQ
MICHIGAN CITY, IN
ZIP 46360-376
Phone: (219) 872-9158
Fax: (219) 873-9196

The provider's authorized official is Paul C Madison .
The authorized official title is Owner and has the following contact phone number (219) 872-9158.

The CLIA number assigned to this NPI record is 15D2001084 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 9/24/2013 and was last updated on 2/17/2017.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP3300X	Clinic/Center	Pain	01031628A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	IN1719	MEDICARE PIN	INDIANA
2	F100107816	MEDICARE PIN	ILLINOIS

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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