Healthcare Provider Details
I. General information
NPI: 1316981616
Provider Name (Legal Business Name): CINCINNATI CENTERS FOR PAIN RELIEF INC
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 06/16/2006
Last Update Date: 01/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
3145 HAMILTON MASON RD STUITE 201
HAMILTON OH
45011-8557
US
IV. Provider business mailing address
PO BOX 127
CINCINNATI OH
45012-0001
US
V. Phone/Fax
- Phone: 513-454-2277
- Fax: 513-454-2288
- Phone: 513-454-2277
- Fax: 513-454-2288
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | N |
| Taxonomy Code | 207LP2900X |
| Taxonomy | Pain Medicine (Anesthesiology) Physician |
| License Number | |
| License Number State | |
| # 2 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 208VP0000X |
| Taxonomy | Pain Medicine Physician |
| License Number | 35-062727 |
| License Number State | OH |
VIII. Authorized Official
Name:
NILESH
B
JOBALIA
Title or Position: PRESIDENT
Credential: MD
Phone: 513-454-2277