Basic Information
| Provider Information | |||||||||
| NPI: | 1710201868 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CENTER FOR SYMPTOM RELIEF LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1161 BETHEL RD. | ||||||||
| Address2: | STE 203 204 | ||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 43220 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144590350 | ||||||||
| FaxNumber: | 6144590355 | ||||||||
| Practice Location | |||||||||
| Address1: | 1161 BETHEL RD STE 203204 | ||||||||
| Address2: | |||||||||
| City: | COLUMBUS | ||||||||
| State: | OH | ||||||||
| PostalCode: | 432202773 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6144590350 | ||||||||
| FaxNumber: | 6144590355 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/18/2010 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| AuthorizedOfficialLastName: | BOURN | ||||||||
| AuthorizedOfficialFirstName: | MICHAEL | ||||||||
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| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 6144590350 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
| NPICertificationDate: | 04/17/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | 34007735 | OH | N | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine | 208VP0014X | 34007735 | OH | Y | 193400000X MULTIPLE SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Interventional Pain Medicine |
No ID Information.