Provider Demographics
NPI:1326472259
Name:I. C. PAIN SOLUTIONS, PC
Entity Type:Organization
Organization Name:I. C. PAIN SOLUTIONS, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:LYDIA
Authorized Official - Middle Name:
Authorized Official - Last Name:FERRELL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:317-781-0067
Mailing Address - Street 1:6325 S EAST ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-7110
Mailing Address - Country:US
Mailing Address - Phone:317-781-0067
Mailing Address - Fax:317-791-1242
Practice Address - Street 1:6325 S EAST ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-7110
Practice Address - Country:US
Practice Address - Phone:317-781-0067
Practice Address - Fax:317-791-1242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-08-27
Last Update Date:2013-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01056802A207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty