Provider Demographics
NPI:1295365005
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:618-726-2500
Mailing Address - Street 1:4972 BENCHMARK CENTRE DR STE 400
Mailing Address - Street 2:
Mailing Address - City:SWANSEA
Mailing Address - State:IL
Mailing Address - Zip Code:62226-2070
Mailing Address - Country:US
Mailing Address - Phone:618-726-2500
Mailing Address - Fax:618-622-0909
Practice Address - Street 1:4972 BENCHMARK CENTRE DR STE 400
Practice Address - Street 2:
Practice Address - City:SWANSEA
Practice Address - State:IL
Practice Address - Zip Code:62226-2070
Practice Address - Country:US
Practice Address - Phone:618-726-2500
Practice Address - Fax:618-622-0909
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-21
Last Update Date:2020-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty