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General NPI Number Information
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NPI Number | 1316536030
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Entity Type | Organization
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Legal Business Name | CLEVELAND PAIN MEDICINE, PLLC
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Dates
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Enumeration Date | 01/17/2021
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Last Update Date | 01/17/2021
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Provider Practice Location Address
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Address Line | 55 MOUSE CREEK RD NW
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City | CLEVELAND
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State | TN
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Zip | 37312-4840
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Country | US
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Telephone | 909-379-5652
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Fax |
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Provider Business Mailing Address
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Address Line | 8424 OOLTEWAH GEORGETOWN RD
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City | OOLTEWAH
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State | TN
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Zip | 37363-5706
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Country | US
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Telephone | 909-910-9155
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Fax |
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Authorized Official
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Title or Position | PHYSICIAN
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Name | DR. JONATHAN BRUCE GEACH
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Credential | MD
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Telephone | 909-910-9155
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number |
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License Number State |
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