Provider Demographics
NPI:1467902585
Name:UPPER VALLEY PAIN CLINIC LLC
Entity Type:Organization
Organization Name:UPPER VALLEY PAIN CLINIC LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TRACY
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMMOND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:937-208-7292
Mailing Address - Street 1:180 S STANFIELD RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-0106
Mailing Address - Country:US
Mailing Address - Phone:937-440-9758
Mailing Address - Fax:937-440-8872
Practice Address - Street 1:180 S STANFIELD RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-0106
Practice Address - Country:US
Practice Address - Phone:937-440-9758
Practice Address - Fax:937-440-8872
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UPPER VALLEY PAIN CLINIC LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-10-13
Last Update Date:2016-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35044224207L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty