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NPI Code Detail

MEDICARE: COMMONWEALTH PAIN ASSOCIATES PLLC

MEDICARE: COMMONWEALTH PAIN ASSOCIATES PLLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332B00000XDurable Medical Equipment & Medical Supplies

General Provider Information

NPI Number : 1336968981
Entity Type Code : Organization
Provider Name (Legal Business Name) : COMMONWEALTH PAIN ASSOCIATES PLLC
Provider Business Mailing Address
First Line : PO BOX 21890
Second Line :
City : BELFAST
State : ME
Zip : 04915-4115
Country : US
Telephone Number : 502-907-0356
Fax Number : 502-919-9780
Provider Business Practice Location Address
First Line : 2041 ANDERSON FERRY RD
Second Line :
City : CINCINNATI
State : OH
Zip : 45238-3325
Country : US
Telephone Number : 513-401-5968
Fax Number : 833-972-4769
Authorized Official
Title or Position : OWNER
Name : JASON CARNES LEWIS
Credential : MD
Telephone Number : 502-855-3919
Provider Enumeration Date : 10/09/2024
Last Update Date : 10/09/2024

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