Healthcare Provider Details

I. General information

NPI: 1063831303
Provider Name (Legal Business Name): PAIN MANAGEMENT GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/15/2014
Last Update Date: 09/12/2022
Certification Date: 09/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

229 W. MAIN CROSS ST STE 58
FINDLAY OH
45840
US

IV. Provider business mailing address

PO BOX 33792
DETROIT MI
48232-3781
US

V. Phone/Fax

Practice location:
  • Phone: 419-721-6358
  • Fax: 800-261-0301
Mailing address:
  • Phone: 800-514-4390
  • Fax: 440-808-3675

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: BRADLEY R HECKER
Title or Position: CFO
Credential:
Phone: 330-438-6352