Provider Demographics
NPI:1609269653
Name:PM&R PAIN FREE, LLC
Entity Type:Organization
Organization Name:PM&R PAIN FREE, LLC
Other - Org Name:SPINE MUSCLES NERVES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOULD
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:614-918-9808
Mailing Address - Street 1:19645 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:STRONGSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:44149-3205
Mailing Address - Country:US
Mailing Address - Phone:440-234-8833
Mailing Address - Fax:440-234-3313
Practice Address - Street 1:450 ALKYRE RUN STE 360
Practice Address - Street 2:
Practice Address - City:WESTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:43082-6914
Practice Address - Country:US
Practice Address - Phone:614-918-9808
Practice Address - Fax:614-918-9807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-03-16
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34009895208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0121242 GROUPMedicaid
OH0121242 GROUPMedicaid