Provider Demographics
NPI:1982844684
Name:KANKAKEE PAIN SURGICAL SUITE, LLC
Entity Type:Organization
Organization Name:KANKAKEE PAIN SURGICAL SUITE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DONALD
Authorized Official - Middle Name:E
Authorized Official - Last Name:ROLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-932-7246
Mailing Address - Street 1:555 W COURT ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KANKAKEE
Mailing Address - State:IL
Mailing Address - Zip Code:60901-3664
Mailing Address - Country:US
Mailing Address - Phone:815-932-7246
Mailing Address - Fax:815-932-7307
Practice Address - Street 1:555 W COURT ST
Practice Address - Street 2:SUITE 100
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3664
Practice Address - Country:US
Practice Address - Phone:815-932-7246
Practice Address - Fax:815-932-7307
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:METRO AREA PAIN CONSULTANTS, LTD.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-20
Last Update Date:2009-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain