Organization
LINDY WYATT MD LLC
Active
Organization
LINDY WYATT MD LLC
Active
Other names
Pain Management of the Ohio Valley
Organization subpart
No
Provider details
NPI number
Authorized official
DR. LINDY WYATT MD/PHD (OWNER)
(937) 672-4730
Entity
Organization
Contact information
Practice address
6406 THORNBERRY CT, SUITE 220B, MASON, OH 45040-7880
(937) 672-4730
(513) 433-5475
Mailing address
PO BOX 42370, CINCINNATI, OH 45242-0370
(937) 672-4730
(513) 433-5475
Taxonomy
Speciality
Code
Description
License number
State
2084N0400X
Neurology Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10831537
CAQH
—
05
—
2018579
—
OH
01
—
35-072489
OH LICENSE
OH
01
—
439-96-3405-00
BWC
OH
01
—
G58818
UPIN
—
Enumeration date
02/04/2009
Last updated
03/11/2010
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