1073897716 NPI number — COMPREHENSIVE PAIN CONSULTANTS OF THE CAROLINAS, PLLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1073897716 NPI number — COMPREHENSIVE PAIN CONSULTANTS OF THE CAROLINAS, PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PAIN CONSULTANTS OF THE CAROLINAS, PLLC
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:
Provider Other Organization Name Type Code:
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:
1073897716
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/07/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 254
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SKYLAND
Provider Business Mailing Address State Name:
NC
Provider Business Mailing Address Postal Code:
28776
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
828-708-9876
Provider Business Mailing Address Fax Number:
828-687-7858

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
26 GLEN COVE DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARDEN
Provider Business Practice Location Address State Name:
NC
Provider Business Practice Location Address Postal Code:
28704-3219
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
941-753-5918
Provider Business Practice Location Address Fax Number:
941-753-5964
Provider Enumeration Date:
09/29/2011

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
EDWARD
Authorized Official Middle Name:
A
Authorized Official Title or Position:
OWNER/PHYSICIAN
Authorized Official Telephone Number:
713-927-7607

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  200300171 , registered in the state of NC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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