1144569385 NPI number — COMPLETE PAIN CARE, LLC

Table of content: (NPI 1144569385)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1144569385 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:
COMPLETE SPINE AND PAIN CARE
Provider Other Organization Name Type Code:
3
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:
1144569385
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:
157 UNION ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MARLBOROUGH
Provider Business Practice Location Address State Name:
MA
Provider Business Practice Location Address Postal Code:
01752-1228
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:
02/07/2013

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
Authorized Official Telephone Number:
508-665-4344

Provider Taxonomy Codes

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

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





Copyright © 2007-2024 www.npivalidator.com