Provider Demographics
NPI:1013223403
Name:NORTHCOAST PAIN SPECIALISTS LLC
Entity Type:Organization
Organization Name:NORTHCOAST PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:CAPOBIANCO
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:440-366-0253
Mailing Address - Street 1:1100 N ABBE RD STE B
Mailing Address - Street 2:
Mailing Address - City:ELYRIA
Mailing Address - State:OH
Mailing Address - Zip Code:44035-1667
Mailing Address - Country:US
Mailing Address - Phone:440-366-0253
Mailing Address - Fax:440-366-0255
Practice Address - Street 1:1100 N ABBE RD STE B
Practice Address - Street 2:
Practice Address - City:ELYRIA
Practice Address - State:OH
Practice Address - Zip Code:44035-1667
Practice Address - Country:US
Practice Address - Phone:440-366-0253
Practice Address - Fax:440-366-0255
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NORTHEAST OHIO HEALTH PROFESSIONALS LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-08-24
Last Update Date:2010-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty