Provider Demographics
NPI:1295979375
Name:ST CYRIL PAIN CLINIC INC
Entity type:Organization
Organization Name:ST CYRIL PAIN CLINIC INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:NAGUIB
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-509-0842
Mailing Address - Street 1:1621 E MARKET ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6640
Mailing Address - Country:US
Mailing Address - Phone:330-856-2881
Mailing Address - Fax:330-856-2883
Practice Address - Street 1:1621 E MARKET ST STE A
Practice Address - Street 2:
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6617
Practice Address - Country:US
Practice Address - Phone:330-856-2881
Practice Address - Fax:330-856-2883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-04-21
Last Update Date:2024-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH35090324208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000612329OtherANTHEM BLUE CROSS/BLUE SHIELD OF OHIO
OHAN4256401Medicare PIN