1326505496 NPI number — COMMONWEALTH PAIN ASSOCIATES 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 1326505496 NPI number — COMMONWEALTH PAIN ASSOCIATES PLLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMONWEALTH PAIN ASSOCIATES 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:
1326505496
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/26/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
120 EXECUTIVE PARK
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LOUISVILLE
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40207-4201
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-409-9925
Provider Business Mailing Address Fax Number:
502-919-9780

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
222 S 1ST ST STE 300
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LOUISVILLE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40202-5302
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-919-9781
Provider Business Practice Location Address Fax Number:
502-919-9751
Provider Enumeration Date:
02/26/2019

Additional Information

Authorized Official

Authorized Official Last Name:
LEWIS
Authorized Official First Name:
JASON
Authorized Official Middle Name:
CARNES
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
502-855-3919

Provider Taxonomy Codes

  • Taxonomy code: 332B00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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