Provider Demographics
NPI:1316326242
Name:ST. MINA INTERVENTIONAL PAIN CENTER, INC
Entity type:Organization
Organization Name:ST. MINA INTERVENTIONAL PAIN CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:
Authorized Official - Last Name:ANDREWS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:216-509-0842
Mailing Address - Street 1:1621 E MARKET ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:WARREN
Mailing Address - State:OH
Mailing Address - Zip Code:44483-6640
Mailing Address - Country:US
Mailing Address - Phone:330-367-5188
Mailing Address - Fax:330-392-0088
Practice Address - Street 1:1621 E MARKET ST
Practice Address - Street 2:SUITE B
Practice Address - City:WARREN
Practice Address - State:OH
Practice Address - Zip Code:44483-6640
Practice Address - Country:US
Practice Address - Phone:330-367-5188
Practice Address - Fax:330-392-0088
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-26
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain