Provider Demographics
NPI:1023044146
Name:ADVANCED PAIN CENTERS LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN CENTERS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:FAISAL
Authorized Official - Middle Name:M
Authorized Official - Last Name:RAHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:219-865-3819
Mailing Address - Street 1:13 W US HIGHWAY 30
Mailing Address - Street 2:SUITE 202
Mailing Address - City:SCHERERVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46375-2266
Mailing Address - Country:US
Mailing Address - Phone:219-865-3819
Mailing Address - Fax:219-865-5401
Practice Address - Street 1:5355 COMMERCE DR
Practice Address - Street 2:
Practice Address - City:CROWN POINT
Practice Address - State:IN
Practice Address - Zip Code:46307-5325
Practice Address - Country:US
Practice Address - Phone:219-756-0600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-23
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN2002497209Medicaid
IL000000098212OtherBCBS
IL000000098212OtherBCBS
IN2002497209Medicaid