Provider Demographics
NPI:1780743732
Name:INTERVENTIONAL PAIN CONSULTANTS, PA
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:BRIAN
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:NICHOL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:501-539-3383
Mailing Address - Street 1:5106 MCCLANAHAN DR
Mailing Address - Street 2:SUITE B
Mailing Address - City:NORTH LITTLE ROCK
Mailing Address - State:AR
Mailing Address - Zip Code:72116-7051
Mailing Address - Country:US
Mailing Address - Phone:501-539-3383
Mailing Address - Fax:
Practice Address - Street 1:5106 MCCLANAHAN DR
Practice Address - Street 2:SUITE B
Practice Address - City:NORTH LITTLE ROCK
Practice Address - State:AR
Practice Address - Zip Code:72116-7051
Practice Address - Country:US
Practice Address - Phone:501-539-3383
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARE-0476207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR5K014Medicare ID - Type Unspecified