Provider Demographics
NPI:1093957789
Name:INTERVENTIONAL PAIN CARE LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SAVITHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUNHIRAMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:636-333-9723
Mailing Address - Street 1:60 BUSINESS PARK DR STE A
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-2828
Mailing Address - Country:US
Mailing Address - Phone:636-728-9460
Mailing Address - Fax:
Practice Address - Street 1:60 BUSINESS PARK DR
Practice Address - Street 2:STE A
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-2827
Practice Address - Country:US
Practice Address - Phone:636-728-9460
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-03-27
Last Update Date:2018-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QP3300X
MO2004011002332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO6600540001Medicare NSC