1760562342 NPI number — COMPREHENSIVE PAIN MANAGEMENT SERVICES INC

Table of content: (NPI 1760562342)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760562342 NPI number — COMPREHENSIVE PAIN MANAGEMENT SERVICES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE PAIN MANAGEMENT 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:
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:
1760562342
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/12/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2051 45TH STREET
Provider Second Line Business Mailing Address:
SUITE 108
Provider Business Mailing Address City Name:
WEST PALM BEACH
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33407
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
561-845-7432
Provider Business Mailing Address Fax Number:
561-845-9750

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2051 45TH ST
Provider Second Line Business Practice Location Address:
SUITE 108
Provider Business Practice Location Address City Name:
WEST PALM BEACH
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33407-2027
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
561-845-7432
Provider Business Practice Location Address Fax Number:
561-845-9750
Provider Enumeration Date:
10/17/2006

Additional Information

Authorized Official

Authorized Official Last Name:
GHIGNONE
Authorized Official First Name:
MARCO
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
561-845-7432

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X , with the licence number:  ME49902 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 048456300 , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".
  • Identifier: 07250 . This is a "BC/BS" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 017187000 . This is a "Florida Medicaid Provider ID" identifier , issued by the state of ( FL ) . This identifiers is of the category "MEDICAID".




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