=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962405878
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | COMPREHENSIVE PAIN CARE MEDICAL CENTERS INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/24/2005
-----------------------------------------------------
Last Update Date | 08/02/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2650 ELM AVE STE 218
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-424-2900
-----------------------------------------------------
Fax | 562-424-3200
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2650 ELM AVE STE 218
-----------------------------------------------------
City | LONG BEACH
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 90806-1653
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 562-485-5020
-----------------------------------------------------
Fax | 562-494-6660
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DR. GEORGES F ELKHOURY
-----------------------------------------------------
Credential | M.D.
-----------------------------------------------------
Telephone | 562-485-5020
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 207LP2900X
-----------------------------------------------------
Taxonomy Name | Pain Medicine (Anesthesiology) Physician
-----------------------------------------------------
License Number | A40394
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------