1053368811 NPI number — MIDWEST PAIN MANAGEMENT, LLC

Table of content: (NPI 1053368811)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1053368811 NPI number — MIDWEST PAIN MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MIDWEST PAIN MANAGEMENT, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1053368811
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5151 MORNING SUN RD
Provider Second Line Business Mailing Address:
STE A
Provider Business Mailing Address City Name:
OXFORD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45056-9545
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-524-5330
Provider Business Mailing Address Fax Number:
513-524-5337

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5151 MORNING SUN RD
Provider Second Line Business Practice Location Address:
STE A
Provider Business Practice Location Address City Name:
OXFORD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
45056-9545
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
513-524-5330
Provider Business Practice Location Address Fax Number:
513-524-5337
Provider Enumeration Date:
05/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
ROSS
Authorized Official First Name:
WILLIAM
Authorized Official Middle Name:
DOUGLAS
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
513-524-5330

Provider Taxonomy Codes

  • Taxonomy code: 207P00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2978489 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: DF1340 . This is a "RR MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: 200525610B , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".
  • Identifier: 200525610 A , issued by the state of ( IN ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com