Provider Demographics
NPI:1255310306
Name:INTEGRATIVE PAIN CENTERS OF AMERICA LTD
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN CENTERS OF AMERICA LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:VENKATESWARA
Authorized Official - Middle Name:R
Authorized Official - Last Name:KARUPARTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-762-7245
Mailing Address - Street 1:PO BOX 850
Mailing Address - Street 2:
Mailing Address - City:MOLINE
Mailing Address - State:IL
Mailing Address - Zip Code:61266-0850
Mailing Address - Country:US
Mailing Address - Phone:309-762-9711
Mailing Address - Fax:309-762-9747
Practice Address - Street 1:2508 25TH ST STE D
Practice Address - Street 2:
Practice Address - City:ROCK ISLAND
Practice Address - State:IL
Practice Address - Zip Code:61201-5419
Practice Address - Country:US
Practice Address - Phone:309-762-7246
Practice Address - Fax:309-762-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-16
Last Update Date:2010-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036083608208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAI16592Medicare PIN
DE8764Medicare PIN
IL704860Medicare PIN