Provider Demographics
NPI:1912982125
Name:METRO AREA PAIN CONSULTANTS, LTD
Entity Type:Organization
Organization Name:METRO AREA PAIN CONSULTANTS, LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:STEPHANY
Authorized Official - Middle Name:
Authorized Official - Last Name:SCOTT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:815-932-7246
Mailing Address - Street 1:PO BOX 723
Mailing Address - Street 2:
Mailing Address - City:MUSKEGON
Mailing Address - State:MI
Mailing Address - Zip Code:49443-0723
Mailing Address - Country:US
Mailing Address - Phone:231-780-6080
Mailing Address - Fax:231-780-6090
Practice Address - Street 1:555 W COURT ST
Practice Address - Street 2:SUITE100
Practice Address - City:KANKAKEE
Practice Address - State:IL
Practice Address - Zip Code:60901-3664
Practice Address - Country:US
Practice Address - Phone:815-932-7246
Practice Address - Fax:815-932-7307
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-12-09
Last Update Date:2008-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCN1391OtherRAILROAD MEDICARE
IL4615091OtherBCBS OF ILLINOIS GROUP #
IL321370Medicare PIN
IL321370Medicare ID - Type UnspecifiedGROUP PRACTICE NUMBER