Provider Demographics
NPI:1669500229
Name:ADVANCED PAIN MANAGEMENT SURGERY,INC
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT SURGERY,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KATRINA
Authorized Official - Middle Name:B
Authorized Official - Last Name:WHITWORTH
Authorized Official - Suffix:
Authorized Official - Credentials:RN,BSN,MHA
Authorized Official - Phone:812-342-8300
Mailing Address - Street 1:PO BOX 1161
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47202-1161
Mailing Address - Country:US
Mailing Address - Phone:812-342-8300
Mailing Address - Fax:812-342-8304
Practice Address - Street 1:4010 W GOELLER BLVD
Practice Address - Street 2:SUITE C
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-8892
Practice Address - Country:US
Practice Address - Phone:812-342-8300
Practice Address - Fax:812-342-8304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-02
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN=========OtherEIN TAX ID
IN214020Medicare PIN