Provider Demographics
NPI:1396851655
Name:AMERICAN PAIN RELIEF INSTITUTE PROF LLC
Entity Type:Organization
Organization Name:AMERICAN PAIN RELIEF INSTITUTE PROF LLC
Other - Org Name:NORTHERN PLAINS PAIN RELIEF INSTITUTE
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:E
Authorized Official - Last Name:COHEN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:605-668-8683
Mailing Address - Street 1:1719 BROADWAY AVE
Mailing Address - Street 2:STE F
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-3700
Mailing Address - Country:US
Mailing Address - Phone:605-668-8683
Mailing Address - Fax:605-665-3755
Practice Address - Street 1:1719 BROADWAY AVE STE F
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-3700
Practice Address - Country:US
Practice Address - Phone:605-668-8683
Practice Address - Fax:605-665-3755
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA2081P2900X
SD2081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA3092791Medicaid
IA42726OtherBLUE CROSS
SD5610800Medicaid
SD4997522OtherBLUE CROSS
IA42726OtherBLUE CROSS
IA3092791Medicaid
IA42726OtherBLUE CROSS
D19230Medicare UPIN