Provider Demographics
NPI:1548290521
Name:ADVANCED CENTER FOR PAIN AND REHAB SC
Entity type:Organization
Organization Name:ADVANCED CENTER FOR PAIN AND REHAB SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OWNER
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:R
Authorized Official - Last Name:VENTURINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:217-787-8200
Mailing Address - Street 1:2060 W WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:62702-6630
Mailing Address - Country:US
Mailing Address - Phone:217-787-8200
Mailing Address - Fax:217-787-8899
Practice Address - Street 1:2060 W WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62702-6630
Practice Address - Country:US
Practice Address - Phone:217-787-8200
Practice Address - Fax:217-787-8899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2019-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL203968Medicare PIN
IL213881Medicare PIN