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General NPI Number Information
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NPI Number | 1700161981
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Entity Type | Organization
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Legal Business Name | COMMONWEALTH PAIN SPECIALISTS, PLLC
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Dates
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Enumeration Date | 10/19/2011
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Last Update Date | 10/07/2019
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Provider Practice Location Address
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Address Line | 279 KINGS DAUGHTERS DR SUITE 100
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City | FRANKFORT
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State | KY
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Zip | 40601
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Country | US
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Telephone | 502-352-2530
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Fax | 502-352-2534
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Provider Business Mailing Address
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Address Line | 7145 E VIRGINIA ST STE 2000
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City | EVANSVILLE
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State | IN
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Zip | 47715-9147
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Country | US
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Telephone | 812-962-7890
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Fax | 812-476-6162
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Authorized Official
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Title or Position | CREDENTIALING SPECIALIST
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Name | TAMIA FISHER
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Credential |
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Telephone | 812-962-7894
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332B00000X
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Taxonomy Name | Durable Medical Equipment & Medical Supplies
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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 | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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