Provider Demographics
NPI:1629241906
Name:PAIN CLINIC LLC
Entity Type:Organization
Organization Name:PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:GENE
Authorized Official - Middle Name:S
Authorized Official - Last Name:GESSNER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:319-330-4392
Mailing Address - Street 1:2180 NORCOR AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:CORALVILLE
Mailing Address - State:IA
Mailing Address - Zip Code:52241-9748
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2180 NORCOR AVE
Practice Address - Street 2:SUITE B
Practice Address - City:CORALVILLE
Practice Address - State:IA
Practice Address - Zip Code:52241-9748
Practice Address - Country:US
Practice Address - Phone:319-330-4392
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-04-08
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28333207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty