Provider Demographics
NPI:1457344392
Name:NORTHCOAST PAIN MANAGEMENT ASSOCIATES, INC
Entity Type:Organization
Organization Name:NORTHCOAST PAIN MANAGEMENT ASSOCIATES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BILLING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:EMAN
Authorized Official - Middle Name:F
Authorized Official - Last Name:SALLOUHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:440-360-7967
Mailing Address - Street 1:PO BOX 45092
Mailing Address - Street 2:
Mailing Address - City:WESTLAKE
Mailing Address - State:OH
Mailing Address - Zip Code:44145-0092
Mailing Address - Country:US
Mailing Address - Phone:440-331-4559
Mailing Address - Fax:
Practice Address - Street 1:25200 CENTER RIDGE RD STE 3400
Practice Address - Street 2:
Practice Address - City:WESTLAKE
Practice Address - State:OH
Practice Address - Zip Code:44145-4145
Practice Address - Country:US
Practice Address - Phone:440-331-4559
Practice Address - Fax:440-331-4843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-25
Last Update Date:2016-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHCH1642OtherRAILROAD MEDICARE
OH2186512Medicaid
OH2186512Medicaid
OH=========-00OtherBWC
OH=========026OtherCARESOURCE
OH=========026OtherCARESOURCE