Healthcare Provider Details

I. General information

NPI: 1699775536
Provider Name (Legal Business Name): PAIN MANAGEMENT ASSOCIATES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/21/2005
Last Update Date: 07/29/2021
Certification Date: 07/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2139 AUBURN AVE
CINCINNATI OH
45219-2906
US

IV. Provider business mailing address

200 NORTHLAND BLVD FL 1
CINCINNATI OH
45246-3604
US

V. Phone/Fax

Practice location:
  • Phone: 513-585-2451
  • Fax: 513-672-4479
Mailing address:
  • Phone: 513-672-4128
  • Fax: 513-672-4479

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DONALD ADKINS
Title or Position: DIRECTOR
Credential:
Phone: 865-293-5328