MEDICARE: NORTHCOAST PAIN SPECIALISTS LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207Q00000X	Family Medicine Physician

General Provider Information

NPI Number	:	1013223403
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHCOAST PAIN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1100 N ABBE RD STE B
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-1667
Country	:	US
Telephone Number	:	440-366-0253
Fax Number	:	440-366-0255

Provider Business Practice Location Address
First Line	:	1100 N ABBE RD STE B
Second Line	:
City	:	ELYRIA
State	:	OH
Zip	:	44035-1667
Country	:	US
Telephone Number	:	440-366-0253
Fax Number	:	440-366-0255

Authorized Official
Title or Position	:	MANAGER
Name	:	MICHAEL CAPOBIANCO
Credential	:	DC
Telephone Number	:	440-366-0253

Provider Enumeration Date	:	08/24/2010
Last Update Date	:	10/12/2010

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Directions to “NORTHCOAST PAIN SPECIALISTS LLC ” Practice Location

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