Provider Demographics
NPI:1376086611
Name:CLINICAL PAIN CONSULTANTS, S.C.
Entity type:Organization
Organization Name:CLINICAL PAIN CONSULTANTS, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:RICHBURG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:414-800-5359
Mailing Address - Street 1:2500 NORTH MAYFAIR ROAD
Mailing Address - Street 2:SUITE 325
Mailing Address - City:WAUWATOSA
Mailing Address - State:WI
Mailing Address - Zip Code:53226
Mailing Address - Country:US
Mailing Address - Phone:414-800-5359
Mailing Address - Fax:414-800-6308
Practice Address - Street 1:2500 NORTH MAYFAIR ROAD
Practice Address - Street 2:SUITE 325
Practice Address - City:WAUWATOSA
Practice Address - State:WI
Practice Address - Zip Code:53226
Practice Address - Country:US
Practice Address - Phone:414-800-5359
Practice Address - Fax:414-800-6308
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-18
Last Update Date:2024-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty