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NPI Code Detail

MEDICARE: COMMONWEALTH PAIN ASSOCIATES PLLC

MEDICARE: COMMONWEALTH PAIN ASSOCIATES PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1208VP0014XInterventional Pain Medicine Physician
2332900000XNon-Pharmacy Dispensing Site

General Provider Information

NPI Number : 1992456651
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMONWEALTH PAIN ASSOCIATES PLLC
Provider Business Mailing Address
First Line : 101 PROSPEROUS PL STE 300
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1836
Country : US
Telephone Number : 859-275-5229
Fax Number : 859-977-2683
Provider Business Practice Location Address
First Line : 101 PROSPEROUS PL STE 300
Second Line :
City : LEXINGTON
State : KY
Zip : 40509-1836
Country : US
Telephone Number : 859-275-5229
Fax Number : 859-977-2683
Authorized Official
Title or Position : PARTNER
Name : BRANDON GISH
Credential :
Telephone Number : 502-855-7200
Provider Enumeration Date : 01/14/2022
Last Update Date : 01/14/2022

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Directions to “COMMONWEALTH PAIN ASSOCIATES PLLC ” Practice Location

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