Provider Demographics
NPI:1588480388
Name:INTERVENTIONAL PAIN AND REGENERATIVE CLINIC LLC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN AND REGENERATIVE CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ANDY
Authorized Official - Middle Name:
Authorized Official - Last Name:DHILLON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:212-463-0911
Mailing Address - Street 1:12989 SOUTHERN BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-9291
Mailing Address - Country:US
Mailing Address - Phone:212-463-0911
Mailing Address - Fax:
Practice Address - Street 1:12989 SOUTHERN BLVD STE 205
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-9291
Practice Address - Country:US
Practice Address - Phone:501-282-0953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-26
Last Update Date:2025-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty