Provider Demographics
NPI:1568497774
Name:OHIO STATE PAIN MANAGEMENT CENTER,LLC
Entity Type:Organization
Organization Name:OHIO STATE PAIN MANAGEMENT CENTER,LLC
Other - Org Name:COLUMBUS INTERVENTIONAL PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SACHIDA
Authorized Official - Middle Name:N
Authorized Official - Last Name:MANOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-262-7246
Mailing Address - Street 1:7036 CORPORATE WAY
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4237
Mailing Address - Country:US
Mailing Address - Phone:937-253-6448
Mailing Address - Fax:937-253-5971
Practice Address - Street 1:3400 OLENTANGY RIVER RD
Practice Address - Street 2:SUITE #100
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43202-1576
Practice Address - Country:US
Practice Address - Phone:614-262-7246
Practice Address - Fax:614-262-4699
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-12
Last Update Date:2008-12-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-082815207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHDF6837OtherRRMEDICARE
OH2843258Medicaid
OH000000392176OtherANTHEM
OH612459400OtherFEDERAL WORKERS
OHDF6837OtherRRMEDICARE
OH000000392176OtherANTHEM
OH6146160001Medicare NSC
OH612459400OtherFEDERAL WORKERS
OHDF6837OtherRRMEDICARE