Provider Demographics
NPI:1346709383
Name:GRAND ISLAND PAIN RELIEF CENTER PC
Entity Type:Organization
Organization Name:GRAND ISLAND PAIN RELIEF CENTER PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PRAVARDHAN
Authorized Official - Middle Name:RAJASHEKAR
Authorized Official - Last Name:BIRTHI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:308-675-3222
Mailing Address - Street 1:403 LEXINGTON CIR
Mailing Address - Street 2:
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-9728
Mailing Address - Country:US
Mailing Address - Phone:308-675-3222
Mailing Address - Fax:308-675-3234
Practice Address - Street 1:403 LEXINGTON CIR
Practice Address - Street 2:
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-9728
Practice Address - Country:US
Practice Address - Phone:308-675-3222
Practice Address - Fax:308-675-3234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-19
Last Update Date:2021-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty