Provider Demographics
NPI:1922285212
Name:THE PAIN MEDICINE & REHABILITATION CENTER, INC
Entity Type:Organization
Organization Name:THE PAIN MEDICINE & REHABILITATION CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:ALEXANDER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-523-3700
Mailing Address - Street 1:PO BOX 926
Mailing Address - Street 2:
Mailing Address - City:SEYMOUR
Mailing Address - State:IN
Mailing Address - Zip Code:47274-0926
Mailing Address - Country:US
Mailing Address - Phone:812-523-3700
Mailing Address - Fax:812-524-2946
Practice Address - Street 1:1425 CORPORATE WAY
Practice Address - Street 2:
Practice Address - City:SEYMOUR
Practice Address - State:IN
Practice Address - Zip Code:47274-3391
Practice Address - Country:US
Practice Address - Phone:812-523-3700
Practice Address - Fax:812-524-2946
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-29
Last Update Date:2009-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01050375A174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND06394OtherRAILROAD MEDICARE
IN230020Medicare PIN
IN256460Medicare PIN