Provider Demographics
NPI:1891856563
Name:PAIN MANAGEMENT AND AESTHETICS LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND AESTHETICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:KEITH
Authorized Official - Middle Name:E
Authorized Official - Last Name:SNOW
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:419-586-1819
Mailing Address - Street 1:123 HAMILTON ST
Mailing Address - Street 2:
Mailing Address - City:CELINA
Mailing Address - State:OH
Mailing Address - Zip Code:45822
Mailing Address - Country:US
Mailing Address - Phone:419-586-1819
Mailing Address - Fax:419-586-1786
Practice Address - Street 1:123 HAMILTON ST
Practice Address - Street 2:
Practice Address - City:CELINA
Practice Address - State:OH
Practice Address - Zip Code:45822
Practice Address - Country:US
Practice Address - Phone:419-586-1819
Practice Address - Fax:419-586-1786
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-13
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHPA9366681Medicare ID - Type UnspecifiedCORPORATION
OHSN0862125Medicare ID - Type UnspecifiedINDIVIDUAL
OHG81835Medicare UPIN