=====================================================
General NPI Number Information
=====================================================
NPI Number | 1104306919
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE PAIN CARE PA
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/21/2018
-----------------------------------------------------
Last Update Date | 04/28/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 201 N SLEMONS ST
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71655-4326
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-224-4545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 510
-----------------------------------------------------
City | MONTICELLO
-----------------------------------------------------
State | AR
-----------------------------------------------------
Zip | 71657-0510
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 870-224-4545
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | NOADIA WORKU
-----------------------------------------------------
Credential | MD
-----------------------------------------------------
Telephone | 720-365-4760
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 208VP0014X
-----------------------------------------------------
Taxonomy Name | Interventional Pain Medicine Physician
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------