Provider Demographics
NPI:1336419621
Name:COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONY
Authorized Official - Middle Name:GHASSAN
Authorized Official - Last Name:LABABIDI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:330-208-2720
Mailing Address - Street 1:2215 EAST WATERLOO ROAD
Mailing Address - Street 2:STE 313
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44312
Mailing Address - Country:US
Mailing Address - Phone:330-208-2720
Mailing Address - Fax:330-208-2721
Practice Address - Street 1:2851 GILCHRIST RD
Practice Address - Street 2:
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44305-4415
Practice Address - Country:US
Practice Address - Phone:330-208-2720
Practice Address - Fax:330-208-2721
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-01-04
Last Update Date:2022-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH36D1101587291U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes291U00000XLaboratoriesClinical Medical Laboratory
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2943819Medicaid