Provider Demographics
NPI:1952368383
Name:PAIN CONSULTANTS, P.C.
Entity Type:Organization
Organization Name:PAIN CONSULTANTS, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:C
Authorized Official - Last Name:DOOLEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:563-344-1050
Mailing Address - Street 1:3400 DEXTER CT
Mailing Address - Street 2:#101
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52807-3461
Mailing Address - Country:US
Mailing Address - Phone:563-344-6600
Mailing Address - Fax:563-344-6699
Practice Address - Street 1:5515 UTICA RIDGE RD SUITE 600
Practice Address - Street 2:
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807-3927
Practice Address - Country:US
Practice Address - Phone:563-344-1050
Practice Address - Fax:563-265-5789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-28
Last Update Date:2012-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0433672Medicaid
I11560Medicare ID - Type Unspecified