MEDICARE: NORTHEAST INDIANA PAIN SPECIALISTS, LLC

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

General Provider Information

NPI Number	:	1376585695
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTHEAST INDIANA PAIN SPECIALISTS, LLC

Provider Business Mailing Address
First Line	:	2914 S REPUBLIC BLVD
Second Line	:
City	:	TOLEDO
State	:	OH
Zip	:	43615-1912
Country	:	US
Telephone Number	:	419-531-8808
Fax Number	:	419-531-8877

Provider Business Practice Location Address
First Line	:	353 N OAK ST
Second Line	:
City	:	COLUMBIA CITY
State	:	IN
Zip	:	46725-1623
Country	:	US
Telephone Number	:	260-248-9304
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF BILLING
Name	:	MRS. KARYN KOVACH
Credential	:
Telephone Number	:	419-531-8808

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	06/18/2008

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