ADVANCED PAIN CARE CLINIC PSC

Provider Demographics

• NPI: 1942378112
• Name: ADVANCED PAIN CARE CLINIC PSC
• Entity Type: Organization
• Organization Name: ADVANCED PAIN CARE CLINIC PSC
• Authorized Official - Title/Position: CREDENTIALING MANAGER
• Authorized Official - First Name: LINDA
• Authorized Official - Last Name: HUNTER
• Authorized Official - Phone: 812-477-7246
• Mailing Address - Street 1: PO BOX 5249
• Mailing Address - City: EVANSVILLE
• Mailing Address - State: IN
• Mailing Address - Zip Code: 47716-5249
• Mailing Address - Country: US
• Mailing Address - Phone: 812-477-7246
• Mailing Address - Fax: 812-477-7240
• Practice Address - Street 1: 1101 PROFESSIONAL BLVD
• Practice Address - City: EVANSVILLE
• Practice Address - State: IN
• Practice Address - Zip Code: 47714-8001
• Practice Address - Country: US
• Practice Address - Phone: 812-477-7246
• Practice Address - Fax: 812-477-7240
• EIN: <UNAVAIL>
• Is Organization Subpart?: No
• Enumeration Date: 2006-12-04
• Last Update Date: 2015-03-19

Provider Licenses

State	License ID	Taxonomies
IN	34004175A	1041C0700X
IN	01055782A	207RS0012X
IN	01039387A	207RS0012X
IN	1062077A	2081P2900X
IN	01066166A	2081P2900X
IN	01036700A	2081P2900X
IN	01055762A	208VP0014X
IN	01038163A	208VP0014X
IN	01029835A	208VP0014X
		363A00000X, 363AM0700X, 363L00000X

Provider Taxonomies

Primary?	Code	Type	Classification	Specialization	Group
Yes	208VP0014X	Allopathic & Osteopathic Physicians	Pain Medicine	Interventional Pain Medicine	Group - Multi-Specialty
No	1041C0700X	Behavioral Health & Social Service Providers	Social Worker	Clinical	Group - Multi-Specialty
No	207RS0012X	Allopathic & Osteopathic Physicians	Internal Medicine	Sleep Medicine	Group - Multi-Specialty
No	2081P2900X	Allopathic & Osteopathic Physicians	Physical Medicine & Rehabilitation	Pain Medicine	Group - Multi-Specialty
No	363A00000X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant		Group - Multi-Specialty
No	363AM0700X	Physician Assistants & Advanced Practice Nursing Providers	Physician Assistant	Medical	Group - Multi-Specialty
No	363L00000X	Physician Assistants & Advanced Practice Nursing Providers	Nurse Practitioner		Group - Multi-Specialty

Provider Identifiers

State	Identifier ID	ID Type	Issuer
KY	65942427	Medicaid
IN	200497580A	Medicaid
KY	7529	Medicare PIN
KY	65942427	Medicaid