Provider Demographics
NPI:1215045877
Name:COMPREHENSIVE PAIN CARE SC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN CARE SC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:HOLLY
Authorized Official - Middle Name:S
Authorized Official - Last Name:CAROBENE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:815-363-8617
Mailing Address - Street 1:PO BOX 5986
Mailing Address - Street 2:
Mailing Address - City:CAROL STREAM
Mailing Address - State:IL
Mailing Address - Zip Code:60197-5986
Mailing Address - Country:US
Mailing Address - Phone:847-677-6410
Mailing Address - Fax:847-677-6420
Practice Address - Street 1:71 W 156TH ST
Practice Address - Street 2:SUITE 205
Practice Address - City:HARVEY
Practice Address - State:IL
Practice Address - Zip Code:60426-4260
Practice Address - Country:US
Practice Address - Phone:708-596-3344
Practice Address - Fax:708-596-3432
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-25
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL036074517208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILCG7161OtherRAILROAD MEDICARE
IL1619176OtherBLUE SHIELD #
ILL86738Medicare PIN
ILCG7161OtherRAILROAD MEDICARE
IL709860Medicare ID - Type UnspecifiedGROUP PROVIDER #
IL1619176OtherBLUE SHIELD #