Provider Demographics
NPI:1295957959
Name:WOODLAND PAIN CENTER
Entity type:Organization
Organization Name:WOODLAND PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CALVERT
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:219-878-9488
Mailing Address - Street 1:8865 W 400 N
Mailing Address - Street 2:STE. 125
Mailing Address - City:MICHIGAN CITY
Mailing Address - State:IN
Mailing Address - Zip Code:46360-9222
Mailing Address - Country:US
Mailing Address - Phone:219-878-9488
Mailing Address - Fax:219-878-9788
Practice Address - Street 1:8865 W 400 N
Practice Address - Street 2:STE. 125
Practice Address - City:MICHIGAN CITY
Practice Address - State:IN
Practice Address - Zip Code:46360-9222
Practice Address - Country:US
Practice Address - Phone:219-878-9488
Practice Address - Fax:219-878-9788
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN01035762174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IND94865Medicare UPIN
IN191820Medicare ID - Type Unspecified