Provider Demographics
NPI:1992927362
Name:OHIO VALLEY PAIN MANAGEMENT CLINIC, INC, PC
Entity type:Organization
Organization Name:OHIO VALLEY PAIN MANAGEMENT CLINIC, INC, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SAMY
Authorized Official - Middle Name:F
Authorized Official - Last Name:SAKLA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:304-234-8161
Mailing Address - Street 1:2000 EOFF STREET
Mailing Address - Street 2:SUITE 506
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003
Mailing Address - Country:US
Mailing Address - Phone:304-234-8161
Mailing Address - Fax:304-234-8171
Practice Address - Street 1:2000 EOFF STREET
Practice Address - Street 2:SUITE 506
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003
Practice Address - Country:US
Practice Address - Phone:304-234-8161
Practice Address - Fax:304-234-8171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-03
Last Update Date:2007-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV3810010440Medicaid
WV3810010440Medicaid
WV0876501Medicare PIN