Interventional Pain Center PLLC

Primary specialty

Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X

Legal business name

INTERVENTIONAL PAIN CENTER PLLC

Practice address

27423 Van Dyke Ave
Warren, MI 48093-2867

Phone

(586) 757-4000

Fax

(586) 755-9880

NPI assigned

Sep 8, 2015

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Rajendra Bothra, MD

Title

Owner

Phone

(586) 757-4000

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1441670400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1487548800000",
    "number": "1013385046",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "27423 VAN DYKE AVE",
            "address_2": "SUITE B",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932867",
            "telephone_number": "586-757-4000",
            "fax_number": "586-755-9880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "27423 VAN DYKE AVE",
            "city": "WARREN",
            "state": "MI",
            "postal_code": "480932867",
            "telephone_number": "586-757-4000",
            "fax_number": "586-755-9880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN CENTER PLLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-09-08",
        "last_updated": "2017-02-20",
        "status": "A",
        "authorized_official_last_name": "BOTHRA",
        "authorized_official_first_name": "RAJENDRA",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "586-757-4000",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Ambulatory Surgical Clinic/Center in Warren, MI
• Providers in Warren, MI by specialty
• Ambulatory Surgical Clinic/Center in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 20, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.