Provider Demographics
NPI:1356654420
Name:RIVER NORTH PAIN MANAGEMENT CONSULTANTS SC
Entity Type:Organization
Organization Name:RIVER NORTH PAIN MANAGEMENT CONSULTANTS SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:AXEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VARGAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:888-951-6471
Mailing Address - Street 1:1049 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:WILMETTE
Mailing Address - State:IL
Mailing Address - Zip Code:60091-1759
Mailing Address - Country:US
Mailing Address - Phone:888-951-6471
Mailing Address - Fax:888-961-6471
Practice Address - Street 1:1213 WILMETTE AVE
Practice Address - Street 2:SUITE # 2G
Practice Address - City:WILMETTE
Practice Address - State:IL
Practice Address - Zip Code:60091-2566
Practice Address - Country:US
Practice Address - Phone:888-951-6471
Practice Address - Fax:888-961-6471
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2015-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty