Provider Demographics
NPI:1154480168
Name:COMPLETE PAIN CARE, LLC
Entity Type:Organization
Organization Name:COMPLETE PAIN CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:S
Authorized Official - Last Name:BASSETT
Authorized Official - Suffix:JR
Authorized Official - Credentials:MD
Authorized Official - Phone:419-534-9823
Mailing Address - Street 1:3700 N HOLLAND SYLVANIA RD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43615-1006
Mailing Address - Country:US
Mailing Address - Phone:419-534-9823
Mailing Address - Fax:419-534-9837
Practice Address - Street 1:3700 N HOLLAND SYLVANIA RD
Practice Address - Street 2:SUITE 100
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43615-1006
Practice Address - Country:US
Practice Address - Phone:419-534-9823
Practice Address - Fax:419-534-9837
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-06
Last Update Date:2009-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2846513Medicaid
OHCOSP03061Medicare PIN