Healthcare Provider Details

I. General information

NPI: 1437858297
Provider Name (Legal Business Name): COMPREHENSIVE PAIN AND SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2023
Last Update Date: 03/01/2023
Certification Date: 03/01/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10744 E US HIGHWAY 36
AVON IN
46123-7982
US

IV. Provider business mailing address

10744 E US HIGHWAY 36
AVON IN
46123-7982
US

V. Phone/Fax

Practice location:
  • Phone: 765-224-6513
  • Fax: 844-440-2328
Mailing address:
  • Phone: 765-224-6513
  • Fax: 844-440-2328

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE ANN GRAVES
Title or Position: CREDENTIALING COORDINATOR
Credential:
Phone: 888-732-4293