Provider Demographics
NPI:1316286677
Name:THE PAIN RELIEF CLINIC, P.C.
Entity type:Organization
Organization Name:THE PAIN RELIEF CLINIC, P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:A
Authorized Official - Last Name:SWANSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:563-594-9833
Mailing Address - Street 1:PO BOX 2441
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:IA
Mailing Address - Zip Code:52809-2441
Mailing Address - Country:US
Mailing Address - Phone:563-323-4329
Mailing Address - Fax:563-324-8486
Practice Address - Street 1:3400 DEXTER COURT
Practice Address - Street 2:SUITE 105
Practice Address - City:DAVENPORT
Practice Address - State:IA
Practice Address - Zip Code:52807
Practice Address - Country:US
Practice Address - Phone:563-594-9833
Practice Address - Fax:563-324-8486
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-02-06
Last Update Date:2013-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA28552207LP2900X
261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IAIA28552Medicaid
IAIA28552Medicaid