Provider Demographics
NPI:1285683110
Name:NORTHWEST OHIO PAIN MANAGEMENT ASSOCIATES, LTD.
Entity Type:Organization
Organization Name:NORTHWEST OHIO PAIN MANAGEMENT ASSOCIATES, LTD.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KIRAN
Authorized Official - Middle Name:C
Authorized Official - Last Name:TAMIRISA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-696-7646
Mailing Address - Street 1:2600 NAVARRE AVE
Mailing Address - Street 2:PAIN CLINIC
Mailing Address - City:OREGON
Mailing Address - State:OH
Mailing Address - Zip Code:43616-3207
Mailing Address - Country:US
Mailing Address - Phone:419-696-7646
Mailing Address - Fax:
Practice Address - Street 1:2600 NAVARRE AVE
Practice Address - Street 2:PAIN CLINIC
Practice Address - City:OREGON
Practice Address - State:OH
Practice Address - Zip Code:43616-3207
Practice Address - Country:US
Practice Address - Phone:419-696-7646
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-08
Last Update Date:2007-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2633190Medicaid
OHCK8940Medicare ID - Type UnspecifiedMEDICARE RAILROAD
OHNO9331931Medicare ID - Type Unspecified