Healthcare Provider Details

I. General information

NPI: 1922337054
Provider Name (Legal Business Name): PEDIATRIC PAIN CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2009
Last Update Date: 06/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5060 BRADENTON AVE SUITE B
DUBLIN OH
43017-3511
US

IV. Provider business mailing address

3982 POWELL RD STE 271
POWELL OH
43065-7662
US

V. Phone/Fax

Practice location:
  • Phone: 614-889-6422
  • Fax: 614-453-8863
Mailing address:
  • Phone: 614-889-6422
  • Fax: 614-453-8863

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL JOSEPH
Title or Position: PRESIDENT
Credential: M.D.
Phone: 614-747-3394