Provider Demographics
NPI:1578800561
Name:COMPLETE PAIN CARE LLC
Entity Type:Organization
Organization Name:COMPLETE PAIN CARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SALLY
Authorized Official - Middle Name:
Authorized Official - Last Name:TINCHER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:765-557-8541
Mailing Address - Street 1:10744 E US HIGHWAY 36
Mailing Address - Street 2:
Mailing Address - City:AVON
Mailing Address - State:IN
Mailing Address - Zip Code:46123-7982
Mailing Address - Country:US
Mailing Address - Phone:317-209-9811
Mailing Address - Fax:317-209-9812
Practice Address - Street 1:10744 E US HIGHWAY 36
Practice Address - Street 2:
Practice Address - City:AVON
Practice Address - State:IN
Practice Address - Zip Code:46123-7982
Practice Address - Country:US
Practice Address - Phone:317-209-9811
Practice Address - Fax:317-209-9812
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1407815624OtherINDIVIDUAL NPI