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General NPI Number Information
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NPI Number | 1720034283
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Entity Type | Organization
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Legal Business Name | MARIETTA PAIN SERVICES, LLC
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Dates
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Enumeration Date | 05/26/2006
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Last Update Date | 12/10/2008
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Provider Practice Location Address
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Address Line | 1106 COLEGATE DR
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City | MARIETTA
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State | OH
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Zip | 45750-1323
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Country | US
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Telephone | 740-373-1541
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Fax | 740-568-2273
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Provider Business Mailing Address
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Address Line | 1106 COLEGATE DR
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City | MARIETTA
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State | OH
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Zip | 45750-1323
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Country | US
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Telephone | 740-373-1541
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Fax | 740-568-2273
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Authorized Official
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Title or Position | PARTNER
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Name | DR. JOSEPH E. CASTLE
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Credential | D.O.
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Telephone | 740-373-1541
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number | 34-007056
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License Number State | OH
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Taxonomy #2
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Taxonomy Code | 208VP0014X
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Taxonomy Name | Interventional Pain Medicine Physician
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License Number | 34-004870
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License Number State | OH
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