Integrative Pain Management SC

Key facts

NPI

1124613732

Entity type

Organization (NPI type 2)

Primary specialty

Anesthesiology Physician 207L00000X

Legal business name

INTEGRATIVE PAIN MANAGEMENT SC

Practice address

3108 Mid Valley Dr
De Pere, WI 54115-9436

Phone

(920) 532-9117

NPI assigned

Mar 5, 2021

Organization subpart

Yes

Parent organization (as reported)

INTEGRATIVE PAIN MANAGEMENT, SC

Authorized official

Name

John Joseph NPI 1801828074

Title

Owner

Phone

(920) 532-9117

Authorized official NPPES reports the authorized official by name only; the link goes to the one practitioner connected to this organization with that name.

Practitioners 6

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• John Joseph, MD Pain Medicine (Anesthesiology) Physician · Menasha, WI · NPI 1801828074
  NPD Authorized official ANESTHESIOLOGY
• Nancy C Bratanow, M.D. Interventional Pain Medicine Physician · Milwaukee, WI · NPI 1346230612
  NPD ANESTHESIOLOGY
• David Bryce, MD Pain Medicine Physician · Middleton, WI · NPI 1194792838
  NPD
• Karen Burr, NP Nurse Practitioner · De Pere, WI · NPI 1356327860
  NPD
• Jay Marvin Hartz, MD Psychiatry Physician · Oshkosh, WI · NPI 1982828885
  NPD
• Yia Lor, NP Family Nurse Practitioner · Little Chute, WI · NPI 1629683065
  NPD

National Provider Directory

Part of

Integrative Pain Management

Locations

Specialties & licenses

Addresses

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Mar 5, 2021.

{
    "created_epoch": "1614902400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1614902400000",
    "number": "1124613732",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3108 MID VALLEY DR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541159436",
            "telephone_number": "920-532-9117"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3108 MID VALLEY DR",
            "city": "DE PERE",
            "state": "WI",
            "postal_code": "541159436",
            "telephone_number": "920-532-9117"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTEGRATIVE PAIN MANAGEMENT SC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "INTEGRATIVE PAIN MANAGEMENT, SC",
        "enumeration_date": "2021-03-05",
        "last_updated": "2021-03-05",
        "certification_date": "2021-02-15",
        "status": "A",
        "authorized_official_last_name": "JOSEPH",
        "authorized_official_first_name": "JOHN",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "920-532-9117"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in De Pere, WI

• Marie D. Ibarra Stafford, LPC
• Yussr M Ibrahim, MD
• In Focus Counseling, LLC
• Infinite Healing, LLC
• Alexa Ingold, PA-C
• Integrative Pain Management SC
• Integrity Health and Wellness LLC
• Lori Jean Jacobs, APNP
• Amy Sara Jakubovsky, D.C.
• James G. Fritsche DDS SC

All providers in De Pere, WI · Anesthesiology Physician in Wisconsin