Healthcare Provider Details

I. General information

NPI: 1285683110
Provider Name (Legal Business Name): NORTHWEST OHIO PAIN MANAGEMENT ASSOCIATES, LTD.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/08/2006
Last Update Date: 07/30/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2600 NAVARRE AVE PAIN CLINIC
OREGON OH
43616-3207
US

IV. Provider business mailing address

2600 NAVARRE AVE PAIN CLINIC
OREGON OH
43616-3207
US

V. Phone/Fax

Practice location:
  • Phone: 419-696-7646
  • Fax:
Mailing address:
  • Phone: 419-696-7646
  • 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: DR. KIRAN C. TAMIRISA
Title or Position: PRESIDENT
Credential: M.D.
Phone: 419-696-7646