Provider Demographics
NPI:1447330766
Name:ACTION SPINE AND PAIN CENTER, PC
Entity type:Organization
Organization Name:ACTION SPINE AND PAIN CENTER, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:DHRUV
Authorized Official - Middle Name:J
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:330-572-0641
Mailing Address - Street 1:3600 W MARKET ST
Mailing Address - Street 2:STE 101
Mailing Address - City:FAIRLAWN
Mailing Address - State:OH
Mailing Address - Zip Code:44333-4540
Mailing Address - Country:US
Mailing Address - Phone:330-666-1400
Mailing Address - Fax:
Practice Address - Street 1:3600 W MARKET ST
Practice Address - Street 2:STE 101
Practice Address - City:FAIRLAWN
Practice Address - State:OH
Practice Address - Zip Code:44333-4540
Practice Address - Country:US
Practice Address - Phone:330-666-1400
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH350840262081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHAC9355231Medicare ID - Type Unspecified