Provider Demographics
NPI:1750595476
Name:KEY PAIN MANAGEMENT AND TREATMENT CENTER, INC
Entity type:Organization
Organization Name:KEY PAIN MANAGEMENT AND TREATMENT CENTER, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:VIMAL
Authorized Official - Middle Name:SHIV
Authorized Official - Last Name:KUMAR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:419-625-6966
Mailing Address - Street 1:PO BOX 1956
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44871-1956
Mailing Address - Country:US
Mailing Address - Phone:419-625-6966
Mailing Address - Fax:419-625-6997
Practice Address - Street 1:2800 HAYES AVE
Practice Address - Street 2:BUILDING A
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-7248
Practice Address - Country:US
Practice Address - Phone:419-625-6966
Practice Address - Fax:419-625-6997
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2014-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH58676208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2061610Medicaid
OHE42249Medicare UPIN
OHKE9291741Medicare ID - Type Unspecified