Provider Demographics
NPI:1649141060
Name:INTERVENTIONAL PAIN SPECIALISTS OF WISCONSIN, SC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN SPECIALISTS OF WISCONSIN, SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:THORSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:715-234-7246
Mailing Address - Street 1:2021 CENEX DR UNIT J
Mailing Address - Street 2:
Mailing Address - City:RICE LAKE
Mailing Address - State:WI
Mailing Address - Zip Code:54868-1892
Mailing Address - Country:US
Mailing Address - Phone:715-234-7246
Mailing Address - Fax:715-234-7242
Practice Address - Street 1:2021 CENEX DR UNIT J
Practice Address - Street 2:
Practice Address - City:RICE LAKE
Practice Address - State:WI
Practice Address - Zip Code:54868-1892
Practice Address - Country:US
Practice Address - Phone:715-234-7246
Practice Address - Fax:715-234-7242
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERVENTIONAL PAIN SPECIALISTS OF WISCONSIN, SC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-09-17
Last Update Date:2025-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty