Healthcare Provider Details

I. General information

NPI: 1932397833
Provider Name (Legal Business Name): THE PAIN CLINIC, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2007
Last Update Date: 10/05/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELAWARE AVE
MARION OH
43302-6475
US

IV. Provider business mailing address

PO BOX 3022
DUBLIN OH
43016-0012
US

V. Phone/Fax

Practice location:
  • Phone: 740-375-0901
  • Fax: 740-375-0040
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. CONSTANCE REDMAN
Title or Position: PRACTICE MANAGER
Credential:
Phone: 614-777-5860