Provider Demographics
NPI:1992972111
Name:PAIN MANAGEMENT INSTITUTE LLC
Entity type:Organization
Organization Name:PAIN MANAGEMENT INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:AYMAN
Authorized Official - Middle Name:HARRIS
Authorized Official - Last Name:BASALI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-202-5580
Mailing Address - Street 1:27739 S WOODLAND RD
Mailing Address - Street 2:
Mailing Address - City:PEPPER PIKE
Mailing Address - State:OH
Mailing Address - Zip Code:44124-5633
Mailing Address - Country:US
Mailing Address - Phone:216-595-1328
Mailing Address - Fax:330-202-5581
Practice Address - Street 1:546 WINTER ST
Practice Address - Street 2:
Practice Address - City:WOOSTER
Practice Address - State:OH
Practice Address - Zip Code:44691-2300
Practice Address - Country:US
Practice Address - Phone:330-202-5580
Practice Address - Fax:330-202-5581
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-15
Last Update Date:2014-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain