Healthcare Provider Details

I. General information

NPI: 1811940182
Provider Name (Legal Business Name): PAIN EVALUATION & MANAGEMENT CENTER OF OHIO, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/18/2006
Last Update Date: 01/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1550 YANKEE PARK PL STE A
CENTERVILLE OH
45458-1838
US

IV. Provider business mailing address

DEPT L-2433
COLUMBUS OH
43260-0001
US

V. Phone/Fax

Practice location:
  • Phone: 937-439-4949
  • Fax: 937-439-4948
Mailing address:
  • Phone: 937-439-4949
  • Fax: 937-439-4948

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. RICHARD MARTIN DONNINI
Title or Position: CO-OWNER
Credential: D.O.
Phone: 937-439-4949