Provider Demographics
NPI:1497959936
Name:PAIN CONSULTANTS OF CENTRAL ILLINOIS LLC
Entity Type:Organization
Organization Name:PAIN CONSULTANTS OF CENTRAL ILLINOIS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:FURRY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:217-464-5839
Mailing Address - Street 1:1800 E LAKE SHORE DR
Mailing Address - Street 2:SUITE 2500
Mailing Address - City:DECATUR
Mailing Address - State:IL
Mailing Address - Zip Code:62521-3810
Mailing Address - Country:US
Mailing Address - Phone:217-464-5839
Mailing Address - Fax:217-464-1693
Practice Address - Street 1:1800 E LAKE SHORE DR
Practice Address - Street 2:SUITE 2500
Practice Address - City:DECATUR
Practice Address - State:IL
Practice Address - Zip Code:62521-3810
Practice Address - Country:US
Practice Address - Phone:217-464-5839
Practice Address - Fax:217-464-1693
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-11
Last Update Date:2023-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty