Provider Demographics
NPI:1720034283
Name:MARIETTA PAIN SERVICES, LLC
Entity Type:Organization
Organization Name:MARIETTA PAIN SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:CASTLE
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:740-373-1541
Mailing Address - Street 1:1106 COLEGATE DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1323
Mailing Address - Country:US
Mailing Address - Phone:740-373-1541
Mailing Address - Fax:740-568-2273
Practice Address - Street 1:1106 COLEGATE DR
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:OH
Practice Address - Zip Code:45750-1323
Practice Address - Country:US
Practice Address - Phone:740-373-1541
Practice Address - Fax:740-568-2273
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-26
Last Update Date:2008-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH34-007056208VP0000X
OH34-004870208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA9354901Medicare ID - Type Unspecified