Provider Demographics
NPI:1053327874
Name:JCB ANESTHESIA & PAIN MANAGEMENT, PC
Entity Type:Organization
Organization Name:JCB ANESTHESIA & PAIN MANAGEMENT, PC
Other - Org Name:COMPREHENSIVE PAIN CLINIC AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:YIA-PEI
Authorized Official - Last Name:CHAO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:260-312-2489
Mailing Address - Street 1:PO BOX 700908
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75370-0908
Mailing Address - Country:US
Mailing Address - Phone:972-212-5858
Mailing Address - Fax:214-291-5635
Practice Address - Street 1:600 EAST BLVD
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-2483
Practice Address - Country:US
Practice Address - Phone:574-523-3103
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-01
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50003982A207LP2900X, 208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INDR2350OtherRAILROAD MEDICARE
IN100376480BMedicaid
IN201012780AMedicaid
IN201012780AMedicaid