Provider Demographics
NPI:1497785273
Name:MIDWEST PAIN INSTITUTE CENTER FOR MINIMALLY INVASIVE SPINE PC
Entity Type:Organization
Organization Name:MIDWEST PAIN INSTITUTE CENTER FOR MINIMALLY INVASIVE SPINE PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARYL
Authorized Official - Middle Name:JO
Authorized Official - Last Name:BORDER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:317-815-8950
Mailing Address - Street 1:12289 HANCOCK ST
Mailing Address - Street 2:STE 34
Mailing Address - City:CARMEL
Mailing Address - State:IN
Mailing Address - Zip Code:46032-5801
Mailing Address - Country:US
Mailing Address - Phone:317-815-8950
Mailing Address - Fax:317-815-8951
Practice Address - Street 1:12289 HANCOCK ST STE 34
Practice Address - Street 2:
Practice Address - City:CARMEL
Practice Address - State:IN
Practice Address - Zip Code:46032-5888
Practice Address - Country:US
Practice Address - Phone:317-815-8950
Practice Address - Fax:317-815-8951
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-04
Last Update Date:2020-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN6216960001Medicare NSC
INCK8694Medicare PIN