Healthcare Provider Details

I. General information

NPI: 1255614277
Provider Name (Legal Business Name): COMPREHENSIVE ANESTHESIA AND MANAGED PAIN SYSTEMS, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/26/2011
Last Update Date: 01/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

750 E 34TH ST
HIBBING MN
55746-2341
US

IV. Provider business mailing address

1200 E 25TH ST
HIBBING MN
55746-3897
US

V. Phone/Fax

Practice location:
  • Phone: 218-312-3002
  • Fax: 218-312-3003
Mailing address:
  • Phone: 218-312-3002
  • Fax: 218-312-3003

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number033673
License Number StateMN

VIII. Authorized Official

Name: JOHN ALAN BURIA
Title or Position: OWNER
Credential: CRNA
Phone: 218-343-1247