Provider Demographics
NPI:1750825766
Name:MILLENNIUM PAIN CENTER
Entity type:Organization
Organization Name:MILLENNIUM PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AUTHORIZED OFFICIAL
Authorized Official - Prefix:
Authorized Official - First Name:RAMSIN
Authorized Official - Middle Name:
Authorized Official - Last Name:BENYAMIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:224-231-4363
Mailing Address - Street 1:1015 S MERCER AVE
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:61701-7107
Mailing Address - Country:US
Mailing Address - Phone:866-642-1525
Mailing Address - Fax:866-642-1525
Practice Address - Street 1:1806 N MARKET ST
Practice Address - Street 2:
Practice Address - City:CHAMPAIGN
Practice Address - State:IL
Practice Address - Zip Code:61822-1312
Practice Address - Country:US
Practice Address - Phone:217-863-2208
Practice Address - Fax:866-642-1525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-12-09
Last Update Date:2016-12-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain