Healthcare Provider Details

I. General information

NPI: 1922281393
Provider Name (Legal Business Name): OHIO PAIN CLINIC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/08/2007
Last Update Date: 12/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7076 CORPORATE WAY SUITE 201
DAYTON OH
45459-4281
US

IV. Provider business mailing address

7076 CORPORATE WAY SUITE 201
DAYTON OH
45459-4281
US

V. Phone/Fax

Practice location:
  • Phone: 937-434-2226
  • Fax:
Mailing address:
  • Phone: 937-434-2226
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number35090518
License Number StateOH

VIII. Authorized Official

Name: DR. AMOL SOIN
Title or Position: CEO
Credential: M.D.
Phone: 937-434-2226