| Tristate Integrative Pain Center | |
|
2516 Washington Ave Evansville IN 47714-2404 | |
| (812) 449-2733 | |
| Not Available |
| Full Name | Tristate Integrative Pain Center |
|---|---|
| Speciality | Family Medicine |
| Location | 2516 Washington Ave, Evansville, Indiana |
| Authorized Official Name and Position | Brant Steven Sanders (PRESIDENT) |
| Authorized Official Contact | 8124492733 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Tristate Integrative Pain Center Po Box 5328 Evansville IN 47716-5328 Ph: (812) 449-2733 | Tristate Integrative Pain Center 2516 Washington Ave Evansville IN 47714-2404 Ph: (812) 449-2733 |
| NPI Number | 1205194677 |
|---|---|
| Provider Enumeration Date | 04/24/2012 |
| Last Update Date | 10/11/2012 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1205194677 | NPI | - | NPPES |
| 200236040 | Medicaid | IN | |
| 201069840 | Medicaid | IN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207Q00000X | Family Medicine | 01048158A (Indiana) | Primary |
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