Pain Management Center of Southern Indiana

Key facts

NPI

1366686404

Entity type

Organization (NPI type 2)

Primary specialty

Pain Medicine Physician 208VP0000X

Legal business name

PAIN MANAGEMENT CENTER OF SOUTHERN INDIANA

Practice address

8802 S Madison Ave
Indianapolis, IN 46227-6459

Phone

(812) 333-7246

Fax

(812) 889-6720

NPI assigned

Apr 20, 2009

Organization subpart

No

Authorized official

Name

Kamal K. Tiwari, MD

Title

Owner

Phone

(812) 333-7246

Practitioners 1

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

• Leslie Ann Vela, NP Family Nurse Practitioner · Bloomington, IN · NPI 1154491223
  NPD (past)

National Provider Directory

Locations

Specialties & licenses

Addresses

Other identifiers

The complete NPPES record for this NPI in the NPI Registry API JSON format, last updated by the provider on Jun 15, 2009.

{
    "created_epoch": "1240185600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1245024000000",
    "number": "1366686404",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4330 S ROCKPORT RD",
            "city": "BLOOMINGTON",
            "state": "IN",
            "postal_code": "474039765",
            "telephone_number": "812-333-7246",
            "fax_number": "812-889-6720"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8802 S MADISON AVE",
            "city": "INDIANAPOLIS",
            "state": "IN",
            "postal_code": "462276459",
            "telephone_number": "812-333-7246",
            "fax_number": "812-889-6720"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN MANAGEMENT CENTER OF SOUTHERN INDIANA",
        "organizational_subpart": "NO",
        "enumeration_date": "2009-04-20",
        "last_updated": "2009-06-15",
        "status": "A",
        "authorized_official_last_name": "TIWARI",
        "authorized_official_first_name": "KAMAL",
        "authorized_official_middle_name": "K.",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "812-333-7246",
        "authorized_official_credential": "MD"
    },
    "taxonomies": [
        {
            "code": "207L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology",
            "state": "IN",
            "license": null,
            "primary": false
        },
        {
            "code": "208VP0000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Pain Medicine",
            "state": "IN",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "100389270",
            "state": "IN"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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All providers in Indianapolis, IN · Pain Medicine Physician in Indiana