Provider Demographics
NPI:1922337054
Name:PEDIATRIC PAIN CARE LLC
Entity Type:Organization
Organization Name:PEDIATRIC PAIN CARE LLC
Other - Org Name:CENTER FOR PEDIATRIC & ADOLESCENT PAIN CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:614-747-3394
Mailing Address - Street 1:3982 POWELL RD
Mailing Address - Street 2:STE 271
Mailing Address - City:POWELL
Mailing Address - State:OH
Mailing Address - Zip Code:43065-7662
Mailing Address - Country:US
Mailing Address - Phone:614-889-6422
Mailing Address - Fax:614-453-8863
Practice Address - Street 1:5060 BRADENTON AVE
Practice Address - Street 2:SUITE B
Practice Address - City:DUBLIN
Practice Address - State:OH
Practice Address - Zip Code:43017-3511
Practice Address - Country:US
Practice Address - Phone:614-889-6422
Practice Address - Fax:614-453-8863
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-21
Last Update Date:2010-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH9388741Medicare PIN