Provider Demographics
NPI:1912019977
Name:PAIN CARE AMERICA
Entity Type:Organization
Organization Name:PAIN CARE AMERICA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER ADMINISTRAT
Authorized Official - Prefix:
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:RICHARD
Authorized Official - Last Name:ANDERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-598-2600
Mailing Address - Street 1:8255 LEMONT RD
Mailing Address - Street 2:STE 200
Mailing Address - City:DARIEN
Mailing Address - State:IL
Mailing Address - Zip Code:60561-1800
Mailing Address - Country:US
Mailing Address - Phone:630-598-2624
Mailing Address - Fax:630-598-2674
Practice Address - Street 1:8255 LEMONT RD
Practice Address - Street 2:STE 200
Practice Address - City:DARIEN
Practice Address - State:IL
Practice Address - Zip Code:60561-1800
Practice Address - Country:US
Practice Address - Phone:630-598-2624
Practice Address - Fax:630-598-2674
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-31
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty
Not Answered2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL2232379OtherBCBS
IL908945Medicare ID - Type UnspecifiedLOCALITY 15
IL208946Medicare ID - Type UnspecifiedLOCALITY 16
IL2232379OtherBCBS