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General NPI Number Information
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NPI Number | 1659192367
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH PAIN ASSOCIATES PLLC
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Dates
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Enumeration Date | 10/24/2024
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Last Update Date | 10/24/2024
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Provider Practice Location Address
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Address Line | 2609 NEW HARTFORD RD STE 3
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City | OWENSBORO
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State | KY
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Zip | 42303-1316
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Country | US
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Telephone | 812-476-7111
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Fax | 812-476-7117
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Provider Business Mailing Address
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Address Line | PO BOX 21890
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City | BELFAST
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State | ME
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Zip | 04915-4115
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Country | US
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Telephone | 502-907-0356
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Fax | 502-919-9780
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Authorized Official
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Title or Position | OWNER
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Name | JASON CARNES LEWIS
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Credential | MD
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Telephone | 502-855-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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