Provider Demographics
NPI:1700913217
Name:INTERVENTIONAL PAIN CONSULTANTS
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:SHIN
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-752-4618
Mailing Address - Street 1:87 SPRINGSIDE DR
Mailing Address - Street 2:SUITE A
Mailing Address - City:AKRON
Mailing Address - State:OH
Mailing Address - Zip Code:44333-2428
Mailing Address - Country:US
Mailing Address - Phone:330-752-4618
Mailing Address - Fax:330-752-4658
Practice Address - Street 1:87 SPRINGSIDE DR
Practice Address - Street 2:SUITE A
Practice Address - City:AKRON
Practice Address - State:OH
Practice Address - Zip Code:44333-2428
Practice Address - Country:US
Practice Address - Phone:330-752-4618
Practice Address - Fax:330-752-4658
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0108798Medicaid
OHSH 0775053Medicare ID - Type Unspecified
OH0108798Medicaid