Provider Demographics
NPI:1376916833
Name:RENOVA PAIN AND RECOVERY CLINICS, LLC
Entity Type:Organization
Organization Name:RENOVA PAIN AND RECOVERY CLINICS, LLC
Other - Org Name:NA
Other - Org Type:Other Name
Authorized Official - Title/Position:MEMBER/MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ZIPPERER
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:907-707-9206
Mailing Address - Street 1:2110 E NORTHERN LIGHTS BLVD
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99508-4154
Mailing Address - Country:US
Mailing Address - Phone:907-707-9206
Mailing Address - Fax:
Practice Address - Street 1:2110 E NORTHERN LIGHTS BLVD
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99508-4154
Practice Address - Country:US
Practice Address - Phone:907-707-9206
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-05
Last Update Date:2015-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207RA0401XAllopathic & Osteopathic PhysiciansInternal MedicineAddiction MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty