Provider Demographics
NPI:1922281393
Name:OHIO PAIN CLINIC, LLC
Entity Type:Organization
Organization Name:OHIO PAIN CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:AMOL
Authorized Official - Middle Name:
Authorized Official - Last Name:SOIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:937-434-2226
Mailing Address - Street 1:7076 CORPORATE WAY
Mailing Address - Street 2:SUITE 201
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45459-4281
Mailing Address - Country:US
Mailing Address - Phone:937-434-2226
Mailing Address - Fax:
Practice Address - Street 1:7076 CORPORATE WAY
Practice Address - Street 2:SUITE 201
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45459-4281
Practice Address - Country:US
Practice Address - Phone:937-434-2226
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-08
Last Update Date:2015-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090518208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty