Healthcare Provider Details

I. General information

NPI: 1689119570
Provider Name (Legal Business Name): COMMONWEALTH INTEGRITY PAIN CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/30/2016
Last Update Date: 02/11/2021
Certification Date: 02/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3260 BLAZER PKWY STE 102
LEXINGTON KY
40509-2116
US

IV. Provider business mailing address

3260 BLAZER PKWY STE 102
LEXINGTON KY
40509-2116
US

V. Phone/Fax

Practice location:
  • Phone: 859-317-8714
  • Fax: 859-368-7681
Mailing address:
  • Phone: 859-317-8714
  • Fax: 859-368-7681

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: JOSEPH SMITH
Title or Position: OWNER
Credential: M.D.
Phone: 859-948-0121