Healthcare Provider Details

I. General information

NPI: 1982184925
Provider Name (Legal Business Name): COMMONWEALTH PAIN ASSOCIATES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2018
Last Update Date: 08/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 11TH ST
CARROLLTON KY
41008-1435
US

IV. Provider business mailing address

120 EXECUTIVE PARK
LOUISVILLE KY
40207-4201
US

V. Phone/Fax

Practice location:
  • Phone: 502-855-7200
  • Fax: 502-855-7201
Mailing address:
  • Phone: 502-907-0356
  • Fax: 502-919-9780

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: JASON CARNES LEWIS
Title or Position: OWNER
Credential:
Phone: 502-855-3919