Provider Demographics
NPI:1568078087
Name:INTERVENTIONAL PAIN CONSULTANTS LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:RANDY
Authorized Official - Middle Name:ROHLAND
Authorized Official - Last Name:PRUETZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:618-205-8302
Mailing Address - Street 1:2023 VADALABENE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062-5846
Mailing Address - Country:US
Mailing Address - Phone:618-288-6722
Mailing Address - Fax:
Practice Address - Street 1:2023 VADALABENE DR STE 300
Practice Address - Street 2:
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062-5846
Practice Address - Country:US
Practice Address - Phone:185-288-6722
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-21
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty