1861686206 NPI number — COMPREHENSIVE CARE ANESTHESIA SERVICES INC

Table of content: (NPI 1861686206)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861686206 NPI number — COMPREHENSIVE CARE ANESTHESIA SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE CARE ANESTHESIA SERVICES INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMPREHENSIVE PAIN SERVICES
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1861686206
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 74994
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CLEVELAND
Provider Business Mailing Address State Name:
OH
Provider Business Mailing Address Postal Code:
44194-0001
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
614-430-5724
Provider Business Mailing Address Fax Number:
614-430-5742

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2815 AARONWOOD AVE NE
Provider Second Line Business Practice Location Address:
AFFINITY PAIN CENTER
Provider Business Practice Location Address City Name:
MASSILLON
Provider Business Practice Location Address State Name:
OH
Provider Business Practice Location Address Postal Code:
44646-2371
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
330-834-4788
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/29/2007

Additional Information

Authorized Official

Authorized Official Last Name:
NIKOLAIDIS
Authorized Official First Name:
FRANK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
330-837-7200

Provider Taxonomy Codes

  • Taxonomy code: 207L00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 2468048 , issued by the state of ( OH ) . This identifiers is of the category "MEDICAID".
  • Identifier: 000000328570 . This is a "ANTHEM BC/BS" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".
  • Identifier: DB1218 . This is a "RAILROAD MEDICARE" identifier , issued by the state of ( OH ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com