Healthcare Provider Details

I. General information

NPI: 1316326242
Provider Name (Legal Business Name): ST. MINA INTERVENTIONAL PAIN CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2015
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

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

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 330-367-5188
  • Fax: 330-392-0088
Mailing address:
  • Phone: 330-367-5188
  • Fax: 330-392-0088

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA1903X
TaxonomyAmbulatory Surgical Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. GEORGE ANDREWS
Title or Position: MEDICAL DIRECTOR
Credential: M.D.
Phone: 216-509-0842