Healthcare Provider Details

I. General information

NPI: 1871691048
Provider Name (Legal Business Name): MARION PAIN CLINIC, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/20/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1199 DELAWARE AVE SUITE 108
MARION OH
43302-6475
US

IV. Provider business mailing address

1199 DELAWARE AVE SUITE 108
MARION OH
43302-6475
US

V. Phone/Fax

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

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number StateOH

VIII. Authorized Official

Name: MS. MEENA CHADHA
Title or Position: OWNER
Credential:
Phone: 740-375-0901