1164684338 NPI number — ADVANCED COMPREHENSIVE PAIN MANAGEMENT, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164684338 NPI number — ADVANCED COMPREHENSIVE PAIN MANAGEMENT, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED COMPREHENSIVE 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:
1164684338
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/27/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
24400 CHAGRIN BLVD STE 200
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BEACHWOOD
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44122-5632
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
440-995-4500
Provider Business Mailing Address Fax Number:
440-995-4585

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
24400 CHAGRIN BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BEACHWOOD
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44122-5642
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
440-995-4500
Provider Business Practice Location Address Fax Number:
440-995-4585
Provider Enumeration Date:
06/30/2008

Additional Information

Authorized Official

Authorized Official Last Name:
SALAMA
Authorized Official First Name:
SHERIF
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
440-995-4500

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , with the licence number:  35-071836 , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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