Healthcare Provider Details

I. General information

NPI: 1841442258
Provider Name (Legal Business Name): PAIN CARE SPECIALISTS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6024 HOOVER RD SUITE A
GROVE CITY OH
43123-8133
US

IV. Provider business mailing address

3645 RIDGE MILL DR
HILLIARD OH
43026-7752
US

V. Phone/Fax

Practice location:
  • Phone: 614-777-5700
  • Fax: 614-777-5777
Mailing address:
  • Phone: 614-777-5700
  • Fax: 614-777-5777

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: PANDURANGA R LINGAM
Title or Position: MEDICAL DIRECTOR/ OWNER
Credential: M.D.
Phone: 614-777-5700