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MIDWEST PAIN MANAGEMENT CENTERSLLC NPI 1962401745


NPI Information

NPI: 1962401745
Provider Name: MIDWEST PAIN MANAGEMENT CENTERS,LLC

Doing Business As: MIDWEST INTERVENTIONAL SPINE SPECIALISTS,LLC

Classification: Clinic/Center - 261QP3300X
Entity Type: Organization

Specialization: Pain

CLIA Number: 15D2010343

Address:
8840 CALUMET AVE
SUITE 103
MUNSTER, IN
ZIP 46321
Phone: (219) 836-7246
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MIDWEST PAIN MANAGEMENT CENTERS,LLC is a pain clinic center in Munster, IN. MIDWEST PAIN MANAGEMENT CENTERS,LLC NPI is 1962401745. The provider is registered as an organization entity type.
The provider Is Doing Business As Midwest Interventional Spine Specialists,llc.

The provider's business location address is:

8840 CALUMET AVE
SUITE 103
MUNSTER, IN
ZIP 46321-529
Phone: (219) 836-7246
Fax: (219) 836-6454

The provider's authorized official is Shanu Kondamuri .
The authorized official title is Medical Director and has the following contact phone number (219) 836-7246.

The CLIA number assigned to this NPI record is 15D2010343 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/14/2005 and was last updated on 3/24/2011.


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
1261QP3300XClinic/CenterPainINDIANAYes

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
190001076OTHERILLINOISBCBS OF ILLINOIS
2200095110AMEDICAIDINDIANA
36473850001MEDICARE NSC
4=========OTHERINDIANAEIN
5CE8846OTHERGEORGIARAILROAD MEDICARE
6409950MEDICARE ID-TYPE UNSPECIFIEDINDIANA

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
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