Provider Demographics
NPI:1083701502
Name:SPINE AND PAIN CARE CONSULTANTS
Entity Type:Organization
Organization Name:SPINE AND PAIN CARE CONSULTANTS
Other - Org Name:PAIN CONSULTANTS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:COATES
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-998-4582
Mailing Address - Street 1:PO BOX 74149
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44194-4149
Mailing Address - Country:US
Mailing Address - Phone:330-998-4582
Mailing Address - Fax:
Practice Address - Street 1:211 STOCKSDALE DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-5507
Practice Address - Country:US
Practice Address - Phone:888-965-7146
Practice Address - Fax:937-642-5537
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-06
Last Update Date:2007-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34003893207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDF2329OtherRAILROAD MEDICARE
OH0673614Medicaid
9364391Medicare PIN
OH0673614Medicaid