Provider Demographics
NPI:1417286378
Name:UNITED PAIN SURGICORE SC
Entity Type:Organization
Organization Name:UNITED PAIN SURGICORE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:VOLODIMIR
Authorized Official - Middle Name:
Authorized Official - Last Name:MARKIV
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-267-0299
Mailing Address - Street 1:P.O BOX 129
Mailing Address - Street 2:
Mailing Address - City:PLAINFIELD
Mailing Address - State:IL
Mailing Address - Zip Code:60544-0129
Mailing Address - Country:US
Mailing Address - Phone:630-267-0299
Mailing Address - Fax:
Practice Address - Street 1:3330 W 177TH STREET
Practice Address - Street 2:
Practice Address - City:HAZEL CREST
Practice Address - State:IL
Practice Address - Zip Code:60429-0000
Practice Address - Country:US
Practice Address - Phone:630-267-0299
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL042619555261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical