Basic Information
| Provider Information | |||||||||
| NPI: | 1285683110 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | NORTHWEST OHIO PAIN MANAGEMENT ASSOCIATES, LTD. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2600 NAVARRE AVE | ||||||||
| Address2: | PAIN CLINIC | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196967646 | ||||||||
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| Practice Location | |||||||||
| Address1: | 2600 NAVARRE AVE | ||||||||
| Address2: | PAIN CLINIC | ||||||||
| City: | OREGON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 436163207 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4196967646 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/08/2006 | ||||||||
| LastUpdateDate: | 07/30/2007 | ||||||||
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| AuthorizedOfficialLastName: | TAMIRISA | ||||||||
| AuthorizedOfficialFirstName: | KIRAN | ||||||||
| AuthorizedOfficialMiddleName: | C. | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4196967646 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207LP2900X | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology | Pain Medicine |
ID Information
| ID | Type | State | Issuer | Description | 2633190 | 05 | OH | MEDICAID |