Provider Demographics
NPI:1275846958
Name:UNIVERSAL PAIN MANAGEMENT INSTITUTE LTD
Entity Type:Organization
Organization Name:UNIVERSAL PAIN MANAGEMENT INSTITUTE LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:ANDREWNITA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-932-7242
Mailing Address - Street 1:461 BROWN BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:BOURBONNAIS
Mailing Address - State:IL
Mailing Address - Zip Code:60914-2463
Mailing Address - Country:US
Mailing Address - Phone:815-932-7242
Mailing Address - Fax:815-932-7307
Practice Address - Street 1:461 BROWN BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:BOURBONNAIS
Practice Address - State:IL
Practice Address - Zip Code:60914-2463
Practice Address - Country:US
Practice Address - Phone:815-932-7242
Practice Address - Fax:815-932-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILIL4378Medicare PIN
ILIL4379Medicare PIN
ILIL4377Medicare PIN