| NPI | 1821257783 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | SHANE R FANCHER President 217-464-5839 |
| Organization Subpart ? | No |
| Primary Taxonomy | 208VP0014X Pain Medicine Interventional Pain Medicine |
| Additional Taxonomies | 207L00000X Anesthesiology |
| 207LP2900X Anesthesiology Pain Medicine | |
| 208VP0000X Pain Medicine Pain Medicine | |
| Enumeration Date | 2008-06-05 |
| Last Update Date | 2008-06-05 |