Provider Demographics
NPI:1942528187
Name:ADVANCED PAIN CARE CLINIC
Entity type:Organization
Organization Name:ADVANCED PAIN CARE CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:PADMA
Authorized Official - Middle Name:SAILAJA
Authorized Official - Last Name:SANAPATI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:812-477-7246
Mailing Address - Street 1:PO BOX 5249
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47716-5249
Mailing Address - Country:US
Mailing Address - Phone:812-477-7246
Mailing Address - Fax:812-477-7240
Practice Address - Street 1:1101 PROFESSIONAL BLVD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-8001
Practice Address - Country:US
Practice Address - Phone:812-477-7246
Practice Address - Fax:812-477-7240
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-12
Last Update Date:2010-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01055762A207RS0012X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RS0012XAllopathic & Osteopathic PhysiciansInternal MedicineSleep MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2184450Medicare PIN