NPIMap

Organization Active NPI

Interventional Pain Consultants LLC

  • Interventional Pain Medicine Physician
  • Maryville, IL
National Provider Identifier
1568078087
Registry record updated Apr 4, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Interventional Pain Medicine PhysicianTaxonomy code 208VP0014X
Legal business name
INTERVENTIONAL PAIN CONSULTANTS LLC
Practice address
2023 Vadalabene Dr Ste 300
Maryville, IL 62062-5846
Phone
(185) 288-6722
NPI assigned
Sep 21, 2020
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Apr 4, 2024

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

Authorized official

Name
Randy Rohland Pruetzel
Title
Manager
Phone
(618) 205-8302

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Interventional Pain Medicine PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 208VP0014X Primary

Addresses

Primary practice location

2023 Vadalabene Dr Ste 300
Maryville, IL 62062-5846

Mailing address

2023 Vadalabene Dr Ste 300
Maryville, IL 62062-5846
Phone (618) 288-6722

National Provider Directory

National Provider Directory

Locations

3 Professional Dr
Ste B
Alton, IL 62002
Phone (618) 219-0855

Practitioners & affiliated clinicians

Practitioners 11

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

NPI Registry JSON

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

{
    "created_epoch": "1600646400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1712188800000",
    "number": "1568078087",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR STE 300",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625846",
            "telephone_number": "618-288-6722"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2023 VADALABENE DR STE 300",
            "city": "MARYVILLE",
            "state": "IL",
            "postal_code": "620625846",
            "telephone_number": "185-288-6722"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "INTERVENTIONAL PAIN CONSULTANTS LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2020-09-21",
        "last_updated": "2024-04-04",
        "certification_date": "2024-04-04",
        "status": "A",
        "authorized_official_last_name": "PRUETZEL",
        "authorized_official_first_name": "RANDY",
        "authorized_official_middle_name": "ROHLAND",
        "authorized_official_title_or_position": "MANAGER",
        "authorized_official_telephone_number": "618-205-8302"
    },
    "taxonomies": [
        {
            "code": "208VP0014X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Pain Medicine, Interventional Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Maryville, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 4, 2024; 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.