Provider Demographics
NPI:1235213380
Name:PAIN MED
Entity Type:Organization
Organization Name:PAIN MED
Other - Org Name:COMMUNITY HOSPITALS OF IN, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHIEF FINANCIAL OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:THOMAS
Authorized Official - Middle Name:P
Authorized Official - Last Name:FISCHER
Authorized Official - Suffix:
Authorized Official - Credentials:CPA
Authorized Official - Phone:317-355-4887
Mailing Address - Street 1:PO BOX 19751
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46219-0751
Mailing Address - Country:US
Mailing Address - Phone:317-355-2223
Mailing Address - Fax:317-355-2205
Practice Address - Street 1:1500 N RITTER AVE
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46219-3027
Practice Address - Country:US
Practice Address - Phone:317-355-2223
Practice Address - Fax:317-355-2205
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCA6165OtherRAILROAD MEDICARE
INCA6165OtherRAILROAD MEDICARE
INCA6165OtherRAILROAD MEDICARE