Provider Demographics
NPI:1033531686
Name:CENTERS FOR PAIN CONTROL INC.
Entity Type:Organization
Organization Name:CENTERS FOR PAIN CONTROL INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:UJWALA
Authorized Official - Middle Name:
Authorized Official - Last Name:PURANIK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:219-476-7246
Mailing Address - Street 1:2211 ROOSEVELT RD
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46383
Mailing Address - Country:US
Mailing Address - Phone:219-476-7246
Mailing Address - Fax:219-476-1713
Practice Address - Street 1:8733 W 400 N
Practice Address - Street 2:
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9330
Practice Address - Country:US
Practice Address - Phone:219-476-7246
Practice Address - Fax:219-476-1713
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CENTERS FOR PAIN CONTROL INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-01-16
Last Update Date:2014-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1063580A208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty