Provider Demographics
NPI:1710201868
Name:CENTER FOR SYMPTOM RELIEF LLC
Entity Type:Organization
Organization Name:CENTER FOR SYMPTOM RELIEF LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:BOURN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-459-0350
Mailing Address - Street 1:1161 BETHEL RD.
Mailing Address - Street 2:STE 203 204
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43220
Mailing Address - Country:US
Mailing Address - Phone:614-459-0350
Mailing Address - Fax:614-459-0355
Practice Address - Street 1:1161 BETHEL RD STE 203204
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43220-2773
Practice Address - Country:US
Practice Address - Phone:614-459-0350
Practice Address - Fax:614-459-0355
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34007735208VP0000X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty