Provider Demographics
NPI:1942591722
Name:MIDWEST CENTER FOR PAIN MANAGEMENT, LLC
Entity Type:Organization
Organization Name:MIDWEST CENTER FOR PAIN MANAGEMENT, LLC
Other - Org Name:MIDWEST WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:BRAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMBLEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:859-746-2444
Mailing Address - Street 1:7986 TANNERS GATE LN
Mailing Address - Street 2:
Mailing Address - City:FLORENCE
Mailing Address - State:KY
Mailing Address - Zip Code:41042-1863
Mailing Address - Country:US
Mailing Address - Phone:859-746-2444
Mailing Address - Fax:859-746-9666
Practice Address - Street 1:693 WAGNER AVE
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:OH
Practice Address - Zip Code:45331-2636
Practice Address - Country:US
Practice Address - Phone:859-746-2444
Practice Address - Fax:859-746-9666
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-04-27
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Multi-Specialty