Provider Demographics
NPI:1093045270
Name:GENEVA PAIN CLINIC LLC
Entity Type:Organization
Organization Name:GENEVA PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:J
Authorized Official - Last Name:KRAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-466-7009
Mailing Address - Street 1:1000 RANDALL RD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:GENEVA
Mailing Address - State:IL
Mailing Address - Zip Code:60134-2590
Mailing Address - Country:US
Mailing Address - Phone:630-845-4099
Mailing Address - Fax:630-845-4098
Practice Address - Street 1:1000 RANDALL RD
Practice Address - Street 2:SUITE 225
Practice Address - City:GENEVA
Practice Address - State:IL
Practice Address - Zip Code:60134-2590
Practice Address - Country:US
Practice Address - Phone:630-845-4099
Practice Address - Fax:630-845-4098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-11
Last Update Date:2010-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty