Provider Demographics
NPI:1053368811
Name:MIDWEST PAIN MANAGEMENT, LLC
Entity type:Organization
Organization Name:MIDWEST PAIN MANAGEMENT, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:DOUGLAS
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:513-524-5330
Mailing Address - Street 1:5151 MORNING SUN RD
Mailing Address - Street 2:STE A
Mailing Address - City:OXFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45056-9545
Mailing Address - Country:US
Mailing Address - Phone:513-524-5330
Mailing Address - Fax:513-524-5337
Practice Address - Street 1:5151 MORNING SUN RD
Practice Address - Street 2:STE A
Practice Address - City:OXFORD
Practice Address - State:OH
Practice Address - Zip Code:45056-9545
Practice Address - Country:US
Practice Address - Phone:513-524-5330
Practice Address - Fax:513-524-5337
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2014-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2978489Medicaid
OHDF1340OtherRR MEDICARE
IN200525610BMedicaid
IN200525610 AMedicaid
OH2978489Medicaid