DR. BO TYLER HEADLAM M.D. NPI 1619939246

NPI Information

  • NPI: 1619939246
  • Provider Name: DR. BO TYLER HEADLAM, M.D.
  • Classification: Pain Medicine - 208VP0014X
  • Specialization: Interventional Pain Medicine
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 1735 27TH ST
    WALLER BUILDING, SUITE 302
    PORTSMOUTH, OH
    ZIP 45662
  • Phone: (740) 356-6808

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NPI Details

DR. Bo Tyler Headlam, M.D. is an interventional pain medicine pain medicine in Portsmouth, OH. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. DR. Bo Tyler Headlam, M.D. NPI is 1619939246. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

1735 27TH ST
WALLER BUILDING, SUITE 302
PORTSMOUTH, OH
ZIP 45662-677
Phone: (740) 356-6808
Fax: (740) 356-6826

The NPI 1619939246 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 4/6/2006 and was last updated on 2/19/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
12081P2900XPhysical Medicine & RehabilitationPain Medicine25588NEBRASKANo
22081P2900XPhysical Medicine & RehabilitationPain Medicine036115263ILLINOISNo
3208VP0000XPain MedicinePain Medicine25588NEBRASKANo
4208VP0014XPain MedicineInterventional Pain Medicine25588NEBRASKANo
5208VP0014XPain MedicineInterventional Pain Medicine036115263ILLINOISNo
62081P2900XPhysical Medicine & RehabilitationPain Medicine35120229OHIONo
7208VP0014XPain MedicineInterventional Pain Medicine35120229OHIONo
8208VP0000XPain MedicinePain Medicine35120229OHIONo
92081P2900XPhysical Medicine & RehabilitationPain Medicine286498NEW YORKNo
10208VP0014XPain MedicineInterventional Pain Medicine286498NEW YORKYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
14632039OTHERILLINOISBCBS GROUP

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

NPI Synchronization or Removal

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