Provider Demographics
NPI:1316536030
Name:CLEVELAND PAIN MEDICINE, PLLC
Entity Type:Organization
Organization Name:CLEVELAND PAIN MEDICINE, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:BRUCE
Authorized Official - Last Name:GEACH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:909-910-9155
Mailing Address - Street 1:8424 OOLTEWAH GEORGETOWN RD
Mailing Address - Street 2:
Mailing Address - City:OOLTEWAH
Mailing Address - State:TN
Mailing Address - Zip Code:37363-5706
Mailing Address - Country:US
Mailing Address - Phone:909-910-9155
Mailing Address - Fax:
Practice Address - Street 1:55 MOUSE CREEK RD NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37312-4840
Practice Address - Country:US
Practice Address - Phone:909-379-5652
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-17
Last Update Date:2021-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain