Healthcare Provider Details

I. General information

NPI: 1417522103
Provider Name (Legal Business Name): INTEGRATED PAIN SOLUTIONS INCORPORATED
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/25/2021
Last Update Date: 05/25/2021
Certification Date: 05/25/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6397 EMERALD PKWY STE 100
DUBLIN OH
43016-2231
US

IV. Provider business mailing address

1210 GEMINI PL STE 300
COLUMBUS OH
43240-6112
US

V. Phone/Fax

Practice location:
  • Phone: 614-383-6450
  • Fax:
Mailing address:
  • Phone: 614-383-6450
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: GLADSTONE C MCDOWELL
Title or Position: PRESIDENT
Credential: MD
Phone: 614-383-6450