Organization
PAIN CARE SURGERY, PC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LAXMAIAH MANCHIKANTI M.D. (MEDICAL DIRECTOR)
(618) 997-7820
Entity
Organization
Contact information
Practice address
108 AIRWAY DR, MARION, IL 62959-5841
(618) 997-7820
(618) 997-6721
Mailing address
108 AIRWAY DR, MARION, IL 62959-5841
(618) 997-7820
(618) 997-6721
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
7002900
IL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
100812
HEALTH ALLIANCE
IL
01
—
BC#50386
BLUE CROSS/BLUE SHIELD
IL
Enumeration date
02/24/2006
Last updated
10/05/2011
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