Provider Demographics
NPI:1225522063
Name:INTERVENTIONAL PAIN CONSULTANTS LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WYNNDEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BUENGER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-465-7177
Mailing Address - Street 1:3 PROFESSIONAL DR STE B
Mailing Address - Street 2:
Mailing Address - City:ALTON
Mailing Address - State:IL
Mailing Address - Zip Code:62002-5067
Mailing Address - Country:US
Mailing Address - Phone:618-465-7177
Mailing Address - Fax:618-465-7176
Practice Address - Street 1:3 PROFESSIONAL DR STE B
Practice Address - Street 2:
Practice Address - City:ALTON
Practice Address - State:IL
Practice Address - Zip Code:62002-5067
Practice Address - Country:US
Practice Address - Phone:618-465-7177
Practice Address - Fax:618-465-7176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-15
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Single Specialty