Provider Demographics
NPI:1124406632
Name:COMPREHENSIVE PAIN ASC, LLC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN ASC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:JG
Authorized Official - Last Name:CHISHOLM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:858-453-7700
Mailing Address - Street 1:PO BOX 501724
Mailing Address - Street 2:
Mailing Address - City:SAN DIEGO
Mailing Address - State:CA
Mailing Address - Zip Code:92150-1724
Mailing Address - Country:US
Mailing Address - Phone:858-453-7700
Mailing Address - Fax:858-798-1225
Practice Address - Street 1:16466 BERNARDO CENTER DR
Practice Address - Street 2:SUITE 177
Practice Address - City:SAN DIEGO
Practice Address - State:CA
Practice Address - Zip Code:92128-2508
Practice Address - Country:US
Practice Address - Phone:858-453-7700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-16
Last Update Date:2015-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical