1558015990 NPI number — COMPREHENSIVE PAIN AND SPINE SPECIALISTS LLC

Table of content: (NPI 1558015990)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558015990 NPI number — COMPREHENSIVE PAIN AND SPINE SPECIALISTS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PAIN AND SPINE SPECIALISTS 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:
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:
1558015990
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3570 N BRIARWOOD LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MUNCIE
Provider Business Mailing Address State Name:
IN
Provider Business Mailing Address Postal Code:
47304-5211
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
765-213-6373
Provider Business Mailing Address Fax Number:
765-213-6377

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2451 INTELLIPLEX DR STE 250
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SHELBYVILLE
Provider Business Practice Location Address State Name:
IN
Provider Business Practice Location Address Postal Code:
46176-8581
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
317-398-5303
Provider Business Practice Location Address Fax Number:
317-398-1816
Provider Enumeration Date:
02/04/2022

Additional Information

Authorized Official

Authorized Official Last Name:
TROBRIDGE
Authorized Official First Name:
ANDREW
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
317-250-7973

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QP3300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





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