=====================================================
General NPI Number Information
=====================================================
NPI Number | 1093785081
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | SOLACE PAIN CONSULTANTS LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/24/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1030 CRICKET LANE SURGI CENTER OF MANSFIELD
-----------------------------------------------------
City | MANSFIELD
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 44906
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-451-7346
-----------------------------------------------------
Fax | 614-451-5846
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 20451
-----------------------------------------------------
City | COLUMBUS
-----------------------------------------------------
State | OH
-----------------------------------------------------
Zip | 43220
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 614-451-7346
-----------------------------------------------------
Fax | 614-451-5846
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | AGENT
-----------------------------------------------------
Name | MR. NATHANIEL P NOBLE
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 614-451-7346
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207L00000X
-----------------------------------------------------
Taxonomy Name | Anesthesiology Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | OH
-----------------------------------------------------