Provider Demographics
NPI:1629209077
Name:INTERVENTIONAL PAIN CONSULTANTS, LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SILLS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:541-324-6250
Mailing Address - Street 1:2925 SISKIYOU BLVD
Mailing Address - Street 2:
Mailing Address - City:MEDFORD
Mailing Address - State:OR
Mailing Address - Zip Code:97504-8179
Mailing Address - Country:US
Mailing Address - Phone:541-324-6250
Mailing Address - Fax:
Practice Address - Street 1:2925 SISKIYOU BLVD
Practice Address - Street 2:
Practice Address - City:MEDFORD
Practice Address - State:OR
Practice Address - Zip Code:97504-8179
Practice Address - Country:US
Practice Address - Phone:541-324-6250
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-08-03
Last Update Date:2009-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORMD25091208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ORI15088Medicare UPIN