Provider Demographics
NPI:1194722058
Name:VALLEY PAIN CARE CENTERS LTD
Entity type:Organization
Organization Name:VALLEY PAIN CARE CENTERS LTD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:COULSON
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:815-749-8993
Mailing Address - Street 1:1879 N NELTNOR BLVD # 224
Mailing Address - Street 2:
Mailing Address - City:WEST CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60185-5932
Mailing Address - Country:US
Mailing Address - Phone:815-766-1258
Mailing Address - Fax:630-343-5372
Practice Address - Street 1:1 KISH HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:DEKALB
Practice Address - State:IL
Practice Address - Zip Code:60115-9602
Practice Address - Country:US
Practice Address - Phone:815-766-1258
Practice Address - Fax:708-469-6614
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-06
Last Update Date:2025-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL0001930204OtherBCBS GROUP #
ILCH9839OtherRAILROAD MEDICARE
IL211254Medicare PIN
ILCH9839OtherRAILROAD MEDICARE