JERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
NPI 1255609574
Non-Pharmacy Dispensing Site in Wood River, IL

Active since December 01, 2011
1702 VAUGHN RD, WOOD RIVER, IL 62095(618) 259-3321 Get Directions Write a Review

NPPES record last updated: January 3, 2012. Verified against the NPPES registry weekly; last sync: July 19, 2026.

About Jerseyville Pain Management Center, S.c. NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

JERSEYVILLE PAIN MANAGEMENT CENTER, S.C. (NPI 1255609574) is a healthcare organization registered as a non-pharmacy dispensing site in Wood River, Illinois and active in the NPI registry since December 2011. The organization lists Bud Chomhirun, Medical Director, as its authorized official.

NPPES Registry Identity

NPI1255609574
Entity TypeOrganization
Primary Taxonomy332900000X
Legal Business NameJERSEYVILLE PAIN MANAGEMENT CENTER, S.C.
Location Address1702 VAUGHN RDWood River, IL 62095-1898
Mailing Address2980 N Beverly Glen Cir, Suite 301Los Angeles, CA 90077-1726 · (310) 474-9809
Organization SubpartYes
Authorized OfficialBud ChomhirunMedical Director · (618) 259-3321
Enumeration DateDecember 1, 2011
Last NPPES UpdateJanuary 3, 2012
NPI 1255609574 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses

Primary SpecialtyNon-Pharmacy Dispensing SiteSuppliers
Taxonomy Code332900000X
Definition

A site other than a pharmacy that dispenses medicinal preparations under the supervision of a physician to patients for self-administration. (e.g. physician offices, ER, Urgent Care Centers, Rural Health Facilities, etc.)

1702 VAUGHN RD, Wood River, IL 62095

Other Providers at the Same Location NPPES 5

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

Pediatrics
1702 VAUGHN RD
WOOD RIVER, IL 62095
Physician Assistant (Medical)
1702 VAUGHN RD
WOOD RIVER, IL 62095
Chiropractor
1702 VAUGHN RD, SUITE 4
WOOD RIVER, IL 62095
Physical Medicine & Rehabilitation (Pain Medicine)
1702 VAUGHN RD
WOOD RIVER, IL 62095
Chiropractor
1702 VAUGHN RD
WOOD RIVER, IL 62095

Frequently Asked Questions

The NPI number assigned to this healthcare provider is 1255609574, enumerated as an "organization" on December 01, 2011.

The provider is located at 1702 VAUGHN RD WOOD RIVER, IL 62095 and the phone number is (618) 259-3321.

Non-Pharmacy Dispensing Site with taxonomy code 332900000X.