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NPI Code Detail

MEDICARE: UPPER VALLEY PAIN CLINIC LLC

MEDICARE: UPPER VALLEY PAIN CLINIC 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
1207L00000XAnesthesiology Physician35044224OH

General Provider Information

NPI Number : 1467902585
Entity Type Code : Organization
Provider Name (Legal Business Name) : UPPER VALLEY PAIN CLINIC LLC
Provider Business Mailing Address
First Line : 180 S STANFIELD RD
Second Line :
City : TROY
State : OH
Zip : 45373-0106
Country : US
Telephone Number : 937-440-9758
Fax Number : 937-440-8872
Provider Business Practice Location Address
First Line : 180 S STANFIELD RD
Second Line :
City : TROY
State : OH
Zip : 45373-0106
Country : US
Telephone Number : 937-440-9758
Fax Number : 937-440-8872
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : TRACY HAMMOND
Credential :
Telephone Number : 937-208-7292
Provider Enumeration Date : 10/13/2016
Last Update Date : 10/13/2016

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Directions to “UPPER VALLEY PAIN CLINIC LLC ” Practice Location

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