Organization
OHIO VALLEY PAIN INTERVENTION LLC
Active
Other names
Genesis Health and Wellness
Organization subpart
No
Provider details
NPI number
Authorized official
SHAUN TYMCHAK DC (OWNER)
(812) 858-1008
Entity
Organization
Contact information
Practice address
8211 W STATE ROUTE 66, NEWBURGH, NEWBURGH, IN 47630-2534
(812) 858-1008
(812) 858-1001
Mailing address
8211 W STATE ROUTE 66, NEWBURGH, NEWBURGH, IN 47630-2534
(812) 858-1008
(812) 858-1001
Taxonomy
Speciality
Code
Description
License number
State
208100000X
Physical Medicine & Rehabilitation Physician
—
IN
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
225100000X
Physical Therapist
05008961A
IN
363L00000X
Nurse Practitioner
71005174A
IN
363L00000X
Nurse Practitioner
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
IN1312
MEDICARE PTAN
IN
Enumeration date
04/25/2012
Last updated
07/07/2015
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