Pain Institute, LTD

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

PAIN INSTITUTE, LTD

Practice address

4972 Benchmark Centre Dr
Swansea, IL 62226-2070

Phone

(931) 905-1720

Fax

(931) 905-1721

NPI assigned

Mar 15, 2011

Organization subpart

No

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

Authorized official

Name

Mr. Kyle M Longo, D.C.

Title

Owner

Phone

(931) 905-1720

Specialties & licenses 3

Addresses

Locations

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

{
    "created_epoch": "1300147200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1312156800000",
    "number": "1437458536",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4972 BENCHMARK CENTRE",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262070",
            "telephone_number": "931-905-1720",
            "fax_number": "931-905-1721"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4972 BENCHMARK CENTRE DR",
            "city": "SWANSEA",
            "state": "IL",
            "postal_code": "622262070",
            "telephone_number": "931-905-1720",
            "fax_number": "931-905-1721"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PAIN INSTITUTE, LTD",
        "organizational_subpart": "NO",
        "enumeration_date": "2011-03-15",
        "last_updated": "2011-08-01",
        "status": "A",
        "authorized_official_last_name": "LONGO",
        "authorized_official_first_name": "KYLE",
        "authorized_official_middle_name": "M",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "931-905-1720",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "D.C."
    },
    "taxonomies": [
        {
            "code": "111N00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Chiropractor",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "225100000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Therapist",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Nurse Practitioner",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 1, 2011; 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.