Healthcare Provider Details

I. General information

NPI: 1700161981
Provider Name (Legal Business Name): COMMONWEALTH PAIN SPECIALISTS, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/19/2011
Last Update Date: 10/07/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 KINGS DAUGHTERS DR SUITE 100
FRANKFORT KY
40601
US

IV. Provider business mailing address

7145 E VIRGINIA ST STE 2000
EVANSVILLE IN
47715-9147
US

V. Phone/Fax

Practice location:
  • Phone: 502-352-2530
  • Fax: 502-352-2534
Mailing address:
  • Phone: 812-962-7890
  • Fax: 812-476-6162

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: TAMIA FISHER
Title or Position: CREDENTIALING SPECIALIST
Credential:
Phone: 812-962-7894