Interventional Pain Management, LTD.

Primary specialty

SpecialistTaxonomy code 174400000X

License

60548471 Issued in IL

Legal business name

INTERVENTIONAL PAIN MANAGEMENT, LTD.

Practice address

10220 Wicker Ave
Suite 3
Saint John, IN 46373-9424

Phone

(219) 515-6943

NPI assigned

Jun 20, 2006

Reactivated

Oct 14, 2015

Last updated

Jan 19, 2016By the provider in NPPES

Organization subpart

No

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

Authorized official

Name

Paul C Pollachek, RN

Title

Administrator

Phone

(708) 474-7650

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1150761600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1453161600000",
    "number": "1033155080",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "18221 TORRENCE AVE",
            "address_2": "SUITE 1C",
            "city": "LANSING",
            "state": "IL",
            "postal_code": "604382870",
            "telephone_number": "708-895-9450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10220 WICKER AVE",
            "address_2": "SUITE 3",
            "city": "SAINT JOHN",
            "state": "IN",
            "postal_code": "463739424",
            "telephone_number": "219-515-6943"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN MANAGEMENT, LTD.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-06-20",
        "last_updated": "2016-01-19",
        "deactivation_date": "2013-08-28",
        "reactivation_date": "2015-10-14",
        "status": "A",
        "authorized_official_last_name": "POLLACHEK",
        "authorized_official_first_name": "PAUL",
        "authorized_official_middle_name": "C",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "708-474-7650",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "IL",
            "license": "60548471",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Specialist in Indiana

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 19, 2016; 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.