Healthcare Provider Details

I. General information

NPI: 1508510942
Provider Name (Legal Business Name): COMPREHENSIVE PAIN AND SPINE SPECIALISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/04/2022
Last Update Date: 02/04/2022
Certification Date: 02/04/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4725 STATESMEN DR STE A
INDIANAPOLIS IN
46250-5645
US

IV. Provider business mailing address

3570 N BRIARWOOD LN
MUNCIE IN
47304-5211
US

V. Phone/Fax

Practice location:
  • Phone: 317-842-7928
  • Fax: 317-841-3337
Mailing address:
  • Phone: 765-213-6373
  • Fax: 765-213-6377

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ANDREW TROBRIDGE
Title or Position: OWNER
Credential: MD
Phone: 317-250-7973