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General NPI Number Information
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NPI Number | 1164703476
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Entity Type | Organization
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Legal Business Name | SUMMIT PAIN SPECIALISTS, INC.
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Dates
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Enumeration Date | 08/31/2011
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Last Update Date | 11/03/2011
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Provider Practice Location Address
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Address Line | 4302 ALLEN RD STE 300 4302 ALLEN RD SUITE 301
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City | STOW
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State | OH
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Zip | 44224-1070
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Country | US
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Telephone | 330-945-7246
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Fax |
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Provider Business Mailing Address
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Address Line | 4302 ALLEN RD STE 300 4302 ALLEN RD SUITE 301
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City | STOW
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State | OH
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Zip | 44224-1070
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Country | US
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Telephone | 330-945-7246
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Fax |
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Authorized Official
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Title or Position | PHARMACY MANAGER
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Name | GREGORY WOOD
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Credential |
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Telephone | 330-945-4346
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 022097600
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License Number State | OH
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