Provider Demographics
NPI:1811940182
Name:PAIN EVALUATION & MANAGEMENT CENTER OF OHIO, INC.
Entity type:Organization
Organization Name:PAIN EVALUATION & MANAGEMENT CENTER OF OHIO, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:MARTIN
Authorized Official - Last Name:DONNINI
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:937-439-4949
Mailing Address - Street 1:DEPT L-2433
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43260-0001
Mailing Address - Country:US
Mailing Address - Phone:937-439-4949
Mailing Address - Fax:937-439-4948
Practice Address - Street 1:1550 YANKEE PARK PL
Practice Address - Street 2:STE A
Practice Address - City:CENTERVILLE
Practice Address - State:OH
Practice Address - Zip Code:45458-1838
Practice Address - Country:US
Practice Address - Phone:937-439-4949
Practice Address - Fax:937-439-4948
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2013-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty
No225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0236104Medicaid
OH0569950002Medicare NSC
OHPA9263611Medicare PIN