Provider Demographics
NPI:1912297599
Name:INTERVENTIONAL PAIN TREATMENT CENTER
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN TREATMENT CENTER
Other - Org Name:THE CENTER FOR PAIN CONTROL
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ELMER
Authorized Official - Middle Name:E
Authorized Official - Last Name:DUNBAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:502-238-2896
Mailing Address - Street 1:444 S 1ST ST
Mailing Address - Street 2:LOUISVILLE SURGERY CENTER
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1474
Mailing Address - Country:US
Mailing Address - Phone:502-238-2896
Mailing Address - Fax:
Practice Address - Street 1:444 S 1ST ST
Practice Address - Street 2:LOUISVILLE SURGERY CENTER
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1474
Practice Address - Country:US
Practice Address - Phone:502-238-2896
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-15
Last Update Date:2011-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY20434261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain