Provider Demographics
NPI:1760894554
Name:IMMEDIATE PAIN CARE OF EVANSTON, LLC
Entity Type:Organization
Organization Name:IMMEDIATE PAIN CARE OF EVANSTON, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STUART
Authorized Official - Middle Name:
Authorized Official - Last Name:BERNSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-560-6506
Mailing Address - Street 1:7986 SOLUTIONS CTR
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-1016
Mailing Address - Country:US
Mailing Address - Phone:630-560-5439
Mailing Address - Fax:630-701-1007
Practice Address - Street 1:7986 SOLUTIONS CTR
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60677-1016
Practice Address - Country:US
Practice Address - Phone:630-560-5439
Practice Address - Fax:630-701-1007
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty