Provider Demographics
NPI:1326532508
Name:INTEGRATIVE PAIN CARE LLC
Entity Type:Organization
Organization Name:INTEGRATIVE PAIN CARE LLC
Other - Org Name:CLEVELAND PAIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ADAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:HEDAYA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-520-9336
Mailing Address - Street 1:25200 CENTER RIDGE RD, STE 3300
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145
Mailing Address - Country:US
Mailing Address - Phone:440-306-3200
Mailing Address - Fax:440-574-0009
Practice Address - Street 1:25200 CENTER RIDGE RD, STE 3300
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145
Practice Address - Country:US
Practice Address - Phone:440-306-3200
Practice Address - Fax:440-574-0009
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-20
Last Update Date:2019-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3003216Medicaid