Provider Demographics
NPI:1134519283
Name:KOCHERT PAIN INSTITUTE LLC
Entity type:Organization
Organization Name:KOCHERT PAIN INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:765-446-5055
Mailing Address - Street 1:3218 DAUGHERTY DR
Mailing Address - Street 2:SUITE 110
Mailing Address - City:LAFAYETTE
Mailing Address - State:IN
Mailing Address - Zip Code:47909-3997
Mailing Address - Country:US
Mailing Address - Phone:765-446-5055
Mailing Address - Fax:765-446-5057
Practice Address - Street 1:3218 DAUGHERTY DR
Practice Address - Street 2:SUITE 110
Practice Address - City:LAFAYETTE
Practice Address - State:IN
Practice Address - Zip Code:47909-3997
Practice Address - Country:US
Practice Address - Phone:765-446-5055
Practice Address - Fax:765-446-5057
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-28
Last Update Date:2015-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01031275A311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility