Provider Demographics
NPI:1376261883
Name:COMPREHENSIVE ARTHRITIS SPINE AND PAIN CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE ARTHRITIS SPINE AND PAIN CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RAMSHA
Authorized Official - Middle Name:
Authorized Official - Last Name:KUDIA
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-325-9420
Mailing Address - Street 1:1301 PLANTATION ISLAND DR S STE 402B
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32080-3118
Mailing Address - Country:US
Mailing Address - Phone:904-325-9420
Mailing Address - Fax:469-733-1034
Practice Address - Street 1:1301 PLANTATION ISLAND DR S STE 402B
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32080-3118
Practice Address - Country:US
Practice Address - Phone:904-325-9420
Practice Address - Fax:469-733-1034
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-08-19
Last Update Date:2022-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207RR0500XAllopathic & Osteopathic PhysiciansInternal MedicineRheumatologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty