Provider Demographics
NPI:1609876259
Name:FAIRFIELD PAIN MANAGEMENT CENTER INC
Entity Type:Organization
Organization Name:FAIRFIELD PAIN MANAGEMENT CENTER INC
Other - Org Name:THE PAINCARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MARTIN
Authorized Official - Middle Name:JOHN
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-833-1700
Mailing Address - Street 1:7901 DILEY RD
Mailing Address - Street 2:SUITE 130
Mailing Address - City:CANAL WINCHESTER
Mailing Address - State:OH
Mailing Address - Zip Code:43110-9612
Mailing Address - Country:US
Mailing Address - Phone:614-833-1700
Mailing Address - Fax:614-833-1701
Practice Address - Street 1:7901 DILEY RD
Practice Address - Street 2:SUITE 130
Practice Address - City:CANAL WINCHESTER
Practice Address - State:OH
Practice Address - Zip Code:43110-9612
Practice Address - Country:US
Practice Address - Phone:614-833-1700
Practice Address - Fax:614-833-1701
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-07-26
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0382269Medicaid
OH2077416Medicaid
OHFA9285791Medicare ID - Type Unspecified
OHFA9285792Medicare PIN