Provider Demographics
NPI:1144674409
Name:PAIN & INTERVENTIONAL RADIOLOGY SPECIALISTS, P.A.
Entity type:Organization
Organization Name:PAIN & INTERVENTIONAL RADIOLOGY SPECIALISTS, P.A.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:WENDEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:870-932-0399
Mailing Address - Street 1:3800 E JOHNSON AVE
Mailing Address - Street 2:STE E
Mailing Address - City:JONESBORO
Mailing Address - State:AR
Mailing Address - Zip Code:72401-1931
Mailing Address - Country:US
Mailing Address - Phone:870-932-0399
Mailing Address - Fax:870-932-0499
Practice Address - Street 1:3800 E JOHNSON AVE
Practice Address - Street 2:STE E
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-1931
Practice Address - Country:US
Practice Address - Phone:870-932-0399
Practice Address - Fax:870-932-0499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-04-22
Last Update Date:2016-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2085R0204XAllopathic & Osteopathic PhysiciansRadiologyVascular & Interventional RadiologyGroup - Multi-Specialty