Provider Demographics
NPI:1598061103
Name:GUARDIAN HEADACHE & PAIN MANAGEMENT INSTITUTE
Entity Type:Organization
Organization Name:GUARDIAN HEADACHE & PAIN MANAGEMENT INSTITUTE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BENJAMIN
Authorized Official - Middle Name:
Authorized Official - Last Name:TAIMOORAZY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:309-287-7601
Mailing Address - Street 1:PO BOX 5488
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:IL
Mailing Address - Zip Code:61601-5488
Mailing Address - Country:US
Mailing Address - Phone:800-444-6110
Mailing Address - Fax:847-615-2858
Practice Address - Street 1:2203 EASTLAND DR
Practice Address - Street 2:SUITE 7
Practice Address - City:BLOOMINGTON
Practice Address - State:IL
Practice Address - Zip Code:61704-7918
Practice Address - Country:US
Practice Address - Phone:800-444-6110
Practice Address - Fax:847-615-2858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-28
Last Update Date:2015-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain