Provider Demographics
NPI:1639336969
Name:NORTHEAST OHIO CENTER FOR PAIN MANAGEMENT, INC.
Entity Type:Organization
Organization Name:NORTHEAST OHIO CENTER FOR PAIN MANAGEMENT, INC.
Other - Org Name:NEOCPM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:RAY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:440-774-7246
Mailing Address - Street 1:60 S PLEASANT ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:OBERLIN
Mailing Address - State:OH
Mailing Address - Zip Code:44074-1633
Mailing Address - Country:US
Mailing Address - Phone:440-774-7246
Mailing Address - Fax:440-776-0129
Practice Address - Street 1:60 S PLEASANT ST
Practice Address - Street 2:SUITE B
Practice Address - City:OBERLIN
Practice Address - State:OH
Practice Address - Zip Code:44074-1633
Practice Address - Country:US
Practice Address - Phone:440-774-7246
Practice Address - Fax:440-776-0129
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-22
Last Update Date:2008-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35-066948261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000215005OtherANTHEM BLUE CROSS BLUE SHIELD