Provider Demographics
NPI:1336314574
Name:IOWA ILLINOIS PAIN CONSULTANTS P.C.
Entity Type:Organization
Organization Name:IOWA ILLINOIS PAIN CONSULTANTS P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TIMOTHY
Authorized Official - Middle Name:JON
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-424-0512
Mailing Address - Street 1:PO BOX 580
Mailing Address - Street 2:
Mailing Address - City:BETTENDORF
Mailing Address - State:IA
Mailing Address - Zip Code:52722-0010
Mailing Address - Country:US
Mailing Address - Phone:563-424-0512
Mailing Address - Fax:563-326-6236
Practice Address - Street 1:3385 DEXTER CT
Practice Address - Street 2:STE 300
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3494
Practice Address - Country:US
Practice Address - Phone:563-424-0512
Practice Address - Fax:563-326-6236
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-29
Last Update Date:2015-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA26118261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA4024711Medicaid
IA14316OtherBLUE CROSS BLUE SHIELD
IL036079595Medicaid
IA14316OtherBLUE CROSS BLUE SHIELD
IA4024711Medicaid
IL036079595Medicaid