Healthcare Provider Details

I. General information

NPI: 1639312689
Provider Name (Legal Business Name): ST CYRIL PAIN CLINIC INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2009
Last Update Date: 08/23/2024
Certification Date: 08/23/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1621 E MARKET ST SUITE A
WARREN OH
44483-6640
US

IV. Provider business mailing address

1621 E MARKET ST SUITE A
WARREN OH
44483-6640
US

V. Phone/Fax

Practice location:
  • Phone: 330-856-2881
  • Fax: 330-856-2883
Mailing address:
  • Phone: 330-856-2881
  • Fax: 330-856-2883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number35090324
License Number StateOH

VIII. Authorized Official

Name: GEORGE NAGUIB ANDREWS
Title or Position: OWNER OF CORPORATION
Credential: M.D.
Phone: 216-509-0842