1386896728 NPI number — COMPLETE PAIN CARE, LLC

Table of content: (NPI 1386896728)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386896728 NPI number — COMPLETE PAIN CARE, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPLETE PAIN CARE, LLC
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:
6
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:
1386896728
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/15/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
600 WORCESTER RD STE 301
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FRAMINGHAM
Provider Business Mailing Address State Name:
MA
Provider Business Mailing Address Postal Code:
01702-5316
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
508-665-4344
Provider Business Mailing Address Fax Number:
508-665-4355

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
148 CHESTNUT ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
NEEDHAM
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
02492-2505
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
508-665-4344
Provider Business Practice Location Address Fax Number:
508-665-4355
Provider Enumeration Date:
10/16/2008

Additional Information

Authorized Official

Authorized Official Last Name:
PEARL
Authorized Official First Name:
JANET
Authorized Official Middle Name:
D
Authorized Official Title or Position:
MEDICAL DIRECTOR/OWNER
Authorized Official Telephone Number:
508-665-4344

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0500796269 . This is a "RRMC" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1543040 . This is a "FIRST HEALTH" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: J19458 . This is a "MEDICARE ADVANTAGE, PPO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1717907 . This is a "AETNA HMO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 2381497 . This is a "AETNA" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: A28830 . This is a "MEDICARE ID TYPE UNSPECIFIED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 156037 . This is a "TUFTS" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 3175090 , issued by the state of ( MA ) . This identifiers is of the category "MEDICAID".
  • Identifier: J18472 . This is a "BLUE CROSS/BLUE SHIELD" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 1779373 . This is a "UNITED" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 273800 . This is a "HARVARD PILGRIM" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".
  • Identifier: 7271010 . This is a "AETNA NON-HMO" identifier , issued by the state of ( MA ) . This identifiers is of the category "OTHER".




Copyright © 2007-2025 www.npivalidator.com