Provider Demographics
NPI:1952667859
Name:PAIN PHYSICIANS OF INDIANA PC
Entity Type:Organization
Organization Name:PAIN PHYSICIANS OF INDIANA PC
Other - Org Name:INTERVENTIONAL PAIN CONSULTANTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CEO/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:TAREK
Authorized Official - Middle Name:HASSAN
Authorized Official - Last Name:SHAHBANDAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-750-9630
Mailing Address - Street 1:PO BOX 10685
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46411-0685
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8687 CONNECTICUT ST
Practice Address - Street 2:STE D
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-5541
Practice Address - Country:US
Practice Address - Phone:219-750-9630
Practice Address - Fax:219-750-9451
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-04
Last Update Date:2015-10-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201066350AMedicaid
IN7402820001Medicare NSC
IN201066350AMedicaid
INDS6632Medicare PIN