KOKOMO PAIN MANAGEMENT LLC NPI 1568771095

NPI Information

NPI: 1568771095
Provider Name: KOKOMO PAIN MANAGEMENT, LLC

Doing Business As: MEDICAL PAIN AND SPINE CARE OF INDIANA

Classification: Clinic/Center - 261QP3300X
Entity Type: Organization

Specialization: Pain

CLIA Number: 15D2015110

Address:
18077 RIVER RD STE 200
NOBLESVILLE, IN
ZIP 46062
Phone: (317) 776-7028
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KOKOMO PAIN MANAGEMENT, LLC is a pain clinic center in Noblesville, IN. KOKOMO PAIN MANAGEMENT, LLC NPI is 1568771095. The provider is registered as an organization entity type.
The provider Is Doing Business As Medical Pain And Spine Care Of Indiana.

The provider's business location address is:

18077 RIVER RD STE 200
NOBLESVILLE, IN
ZIP 46062-334
Phone: (317) 776-7028
Fax: (317) 773-7910

The provider's authorized official is John Peter Klim .
The authorized official title is President and has the following contact phone number (317) 776-7028.

The CLIA number assigned to this NPI record is 15D2015110 - physician office with a certificate type of Certificate of Compliance.

The enumeration date for this NPI number is 10/1/2010 and was last updated on 11/20/2019.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	261QP3300X	Clinic/Center	Pain	02002790A	INDIANA	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	200998560	MEDICAID	INDIANA

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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