Provider Demographics
NPI:1205911716
Name:INTERVENTIONAL PAIN CENTER OF MERCED
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN CENTER OF MERCED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RAMAKRISHNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:THONDAPU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:209-724-0316
Mailing Address - Street 1:1390 E YOSEMITE AVE STE C
Mailing Address - Street 2:
Mailing Address - City:MERCED
Mailing Address - State:CA
Mailing Address - Zip Code:95340-8221
Mailing Address - Country:US
Mailing Address - Phone:209-724-0316
Mailing Address - Fax:209-724-0318
Practice Address - Street 1:1390 E YOSEMITE AVE STE C
Practice Address - Street 2:
Practice Address - City:MERCED
Practice Address - State:CA
Practice Address - Zip Code:95340-8221
Practice Address - Country:US
Practice Address - Phone:209-724-0316
Practice Address - Fax:209-724-0318
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-25
Last Update Date:2017-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA550000054261QA1903X, 261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical