1508035957 NPI number — PRECISION PAIN CARE INC

Table of content: (NPI 1508035957)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1508035957 NPI number — PRECISION PAIN CARE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PRECISION PAIN CARE INC
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:
1508035957
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
200 NORTHLAND BLVD
Provider Second Line Business Mailing Address:
1ST FLOOR
Provider Business Mailing Address City Name:
CINCINNATI
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
45246-3604
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
513-672-3300
Provider Business Mailing Address Fax Number:
513-672-3323

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1533 ELECTION HOUSE RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LANCASTER
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
43130-9059
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
740-689-3120
Provider Business Practice Location Address Fax Number:
513-672-3323
Provider Enumeration Date:
02/29/2008

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
LINEHAN
Authorized Official First Name:
RONALD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
740-689-3120

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 332B00000X , registered in the state of OH ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 2846380 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".