Provider Demographics
NPI:1801077243
Name:PAIN MANAGEMENT CENTER, S.C.
Entity type:Organization
Organization Name:PAIN MANAGEMENT CENTER, S.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:BABU
Authorized Official - Middle Name:
Authorized Official - Last Name:PRASAD
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:618-985-3929
Mailing Address - Street 1:108 N DIVISION ST
Mailing Address - Street 2:
Mailing Address - City:CARTERVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62918-1245
Mailing Address - Country:US
Mailing Address - Phone:618-985-3929
Mailing Address - Fax:618-985-9576
Practice Address - Street 1:108 N DIVISION ST
Practice Address - Street 2:
Practice Address - City:CARTERVILLE
Practice Address - State:IL
Practice Address - Zip Code:62918-1245
Practice Address - Country:US
Practice Address - Phone:618-985-3929
Practice Address - Fax:618-985-9576
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-11-14
Last Update Date:2016-06-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILC78689Medicare UPIN