Provider Demographics
NPI:1578707659
Name:ST CYRIL PAIN CLINIC
Entity Type:Organization
Organization Name:ST CYRIL PAIN CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NAGUIB
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-509-0842
Mailing Address - Street 1:909 SAHARA TRL
Mailing Address - Street 2:STE B
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44514-3691
Mailing Address - Country:US
Mailing Address - Phone:330-729-0111
Mailing Address - Fax:330-729-1333
Practice Address - Street 1:2600 ELM RD NE
Practice Address - Street 2:
Practice Address - City:CORTLAND
Practice Address - State:OH
Practice Address - Zip Code:44410-9393
Practice Address - Country:US
Practice Address - Phone:330-729-0111
Practice Address - Fax:330-729-1333
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ST CYRIL PAIN CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-04-21
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090324208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000612329OtherANTHEM BLUE CROSS/BLUE SHIELD OF OHIO
OHAN4256401Medicare PIN