Provider Demographics
NPI:1043373152
Name:SUMMIT PAIN SPECIALISTS INC
Entity type:Organization
Organization Name:SUMMIT PAIN SPECIALISTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGED CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:SPONSELLER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:330-945-9551
Mailing Address - Street 1:4302 ALLEN RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:STOW
Mailing Address - State:OH
Mailing Address - Zip Code:44224-1032
Mailing Address - Country:US
Mailing Address - Phone:330-945-9551
Mailing Address - Fax:330-945-9920
Practice Address - Street 1:4302 ALLEN RD
Practice Address - Street 2:SUITE 300
Practice Address - City:STOW
Practice Address - State:OH
Practice Address - Zip Code:44224-1032
Practice Address - Country:US
Practice Address - Phone:330-945-9551
Practice Address - Fax:330-945-9920
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2010-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2259532Medicaid
OH2259532Medicaid