MEDICARE: OHIO INSTITUTE FOR COMPREHENSIVE PAIN MANAGEMENT, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2	36D1095868	OTHER	OH	CLIA

General Provider Information

NPI Number	:	1164594834
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OHIO INSTITUTE FOR COMPREHENSIVE PAIN MANAGEMENT, INC.

Provider Business Mailing Address
First Line	:	1235 E ALEX BELL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-2658
Country	:	US
Telephone Number	:	937-435-6400
Fax Number	:	937-435-4793

Provider Business Practice Location Address
First Line	:	1235 E ALEX BELL RD
Second Line	:
City	:	DAYTON
State	:	OH
Zip	:	45459-2658
Country	:	US
Telephone Number	:	937-435-6400
Fax Number	:	937-435-4793

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MERVET K SALEH
Credential	:	M.D.
Telephone Number	:	937-435-6400

Provider Enumeration Date	:	11/15/2006
Last Update Date	:	02/21/2012

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