Provider Demographics
NPI:1497841068
Name:GAVIN D CHARTIER LLC
Entity Type:Organization
Organization Name:GAVIN D CHARTIER LLC
Other - Org Name:WILLOW CREEK PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNDER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:GAVIN
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:CHARTIER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-886-1151
Mailing Address - Street 1:328 N 2ND ST
Mailing Address - Street 2:SUITE 308
Mailing Address - City:VINCENNES
Mailing Address - State:IN
Mailing Address - Zip Code:47591-1351
Mailing Address - Country:US
Mailing Address - Phone:812-886-1151
Mailing Address - Fax:812-886-5330
Practice Address - Street 1:328 N 2ND ST
Practice Address - Street 2:SUITE 308
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1351
Practice Address - Country:US
Practice Address - Phone:812-886-1151
Practice Address - Fax:812-886-5330
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-04
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01041179208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty