Provider Demographics
NPI:1346399268
Name:CENTER FOR PAIN CONTROL, P.C.
Entity Type:Organization
Organization Name:CENTER FOR PAIN CONTROL, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:W
Authorized Official - Last Name:IRWIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:847-549-1609
Mailing Address - Street 1:1800 HOLLISTER DR
Mailing Address - Street 2:SUITE 206
Mailing Address - City:LIBERTYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:60048-5263
Mailing Address - Country:US
Mailing Address - Phone:847-549-1609
Mailing Address - Fax:847-549-1646
Practice Address - Street 1:1800 HOLLISTER DR
Practice Address - Street 2:SUITE 206
Practice Address - City:LIBERTYVILLE
Practice Address - State:IL
Practice Address - Zip Code:60048-5263
Practice Address - Country:US
Practice Address - Phone:847-549-1609
Practice Address - Fax:847-549-1646
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-09
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL60008451174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL369290Medicare ID - Type Unspecified