Organization
PAIN MANAGEMENT & SURGERY CENTER OF SOUTHERN INDIANA
Active
Organization subpart
No
Provider details
NPI number
Authorized official
KAMAL KUMAR TIWARI MD (PRESIDENT)
(812) 824-5688
Entity
Organization
Contact information
Practice address
2920 MCINTYRE DR, SUITE 150, BLOOMINGTON, IN 47403-4221
(812) 333-7246
(812) 333-4471
Mailing address
PO BOX 5635, ATTN MARIA MITCHELL, BLOOMINGTON, IN 47407-5635
(812) 824-5688
(812) 824-5692
Taxonomy
Speciality
Code
Description
License number
State
261QA1903X
Ambulatory Surgical Clinic/Center
Primary
61100223B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000098134
ANTHEM
IN
Enumeration date
09/15/2005
Last updated
08/22/2020
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