Provider Demographics
NPI:1073798427
Name:BRUCE MASSAU, D.O., P.C.
Entity Type:Organization
Organization Name:BRUCE MASSAU, D.O., P.C.
Other - Org Name:PAIN MANAGMENT CONSORTIUM OF OHIO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BRUCE
Authorized Official - Middle Name:
Authorized Official - Last Name:MASSAU
Authorized Official - Suffix:
Authorized Official - Credentials:DO A PROF
Authorized Official - Phone:614-252-1500
Mailing Address - Street 1:393 E TOWN ST
Mailing Address - Street 2:SUITE 109
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43215-4741
Mailing Address - Country:US
Mailing Address - Phone:614-252-1500
Mailing Address - Fax:614-252-1685
Practice Address - Street 1:393 E TOWN ST
Practice Address - Street 2:SUITE 109
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43215-4741
Practice Address - Country:US
Practice Address - Phone:614-252-1500
Practice Address - Fax:614-252-1685
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2011-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0472662Medicaid
OH9262861Medicare PIN
OH0472662Medicaid