Provider Demographics
NPI:1952771974
Name:ADVANCE PAIN RELIEF OF INDIANA INC
Entity Type:Organization
Organization Name:ADVANCE PAIN RELIEF OF INDIANA INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:LUSHINSKY
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:317-385-7620
Mailing Address - Street 1:2976 N SCATTERFIELD RD STE 150
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:IN
Mailing Address - Zip Code:46012-1587
Mailing Address - Country:US
Mailing Address - Phone:765-643-8781
Mailing Address - Fax:765-622-0126
Practice Address - Street 1:2976 N SCATTERFIELD RD STE 150
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:IN
Practice Address - Zip Code:46012-1587
Practice Address - Country:US
Practice Address - Phone:765-643-8781
Practice Address - Fax:765-622-0126
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-10-02
Last Update Date:2015-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN08001691A111N00000X
IN01071236A207L00000X, 208VP0014X
IN05008752A225100000X
332B00000X
IN28173385A363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No111N00000XChiropractic ProvidersChiropractorGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty