Healthcare Provider Details

I. General information

NPI: 1619044005
Provider Name (Legal Business Name): GREATER CINCINNATI PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 11/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4243 HUNT RD
CINCINNATI OH
45242-6645
US

IV. Provider business mailing address

4243 HUNT RD
CINCINNATI OH
45242-6645
US

V. Phone/Fax

Practice location:
  • Phone: 513-794-5107
  • Fax: 513-791-2680
Mailing address:
  • Phone: 513-794-5107
  • Fax: 513-791-2680

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License Number
License Number StateNULL
# 4
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number StateNULL

VIII. Authorized Official

Name: DR. MITCHELL E SIMONS
Title or Position: PHYSICIAN-OWNER-PRESIDENT
Credential: M.D.
Phone: 513-794-5107