Provider Demographics
NPI:1821790965
Name:IREDELL PHYSICIAN NETWORK, LLC
Entity Type:Organization
Organization Name:IREDELL PHYSICIAN NETWORK, LLC
Other - Org Name:IREDELL PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING AGENT
Authorized Official - Prefix:
Authorized Official - First Name:JOANIE
Authorized Official - Middle Name:M
Authorized Official - Last Name:COCHRAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:336-306-9755
Mailing Address - Street 1:653 BLUEFIELD RD STE H
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28117-9599
Mailing Address - Country:US
Mailing Address - Phone:336-306-9755
Mailing Address - Fax:
Practice Address - Street 1:653 BLUEFIELD RD STE H
Practice Address - Street 2:
Practice Address - City:MOORESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28117-9599
Practice Address - Country:US
Practice Address - Phone:336-306-9755
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:IREDELL PHYSICIAN NETWORK, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-21
Last Update Date:2023-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty