Midwest Pain & Spine Center, LLC

Primary specialty

SpecialistTaxonomy code 174400000X

Legal business name

MIDWEST PAIN & SPINE CENTER, LLC

Practice address

5401 N Knoxville Ave
Suite 416
Peoria, IL 61614-5098

Phone

(309) 692-7246

Fax

(309) 692-7226

NPI assigned

Oct 7, 2015

Organization subpart

No

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

Authorized official

Name

Gayle Mucciante

Title

Practice Administrator

Phone

(309) 692-7246

Specialties & licenses 1

Addresses

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

{
    "created_epoch": "1444176000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1445558400000",
    "number": "1679944334",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 416",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-692-7246",
            "fax_number": "309-692-7226"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5401 N KNOXVILLE AVE",
            "address_2": "SUITE 416",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616145098",
            "telephone_number": "309-692-7246",
            "fax_number": "309-692-7226"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MIDWEST PAIN & SPINE CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2015-10-07",
        "last_updated": "2015-10-23",
        "status": "A",
        "authorized_official_last_name": "MUCCIANTE",
        "authorized_official_first_name": "GAYLE",
        "authorized_official_title_or_position": "PRACTICE ADMINISTRATOR",
        "authorized_official_telephone_number": "309-692-7246"
    },
    "taxonomies": [
        {
            "code": "174400000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Specialist",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Jeffrey Benjamin Miessau, PA-C

• All providers in Peoria, IL
• Specialist in Illinois

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 23, 2015; 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.