Provider Demographics
NPI:1376795823
Name:COMPLETE PAIN MANAGEMENT & REHABILITATION LLC
Entity Type:Organization
Organization Name:COMPLETE PAIN MANAGEMENT & REHABILITATION LLC
Other - Org Name:DYNAMIC PAIN REHABILITATION
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ALEXANDER
Authorized Official - Middle Name:
Authorized Official - Last Name:IMAS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:702-982-7100
Mailing Address - Street 1:PO BOX 531666
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89053-1666
Mailing Address - Country:US
Mailing Address - Phone:702-982-7100
Mailing Address - Fax:702-982-7102
Practice Address - Street 1:1358 PASEO VERDE PKWY
Practice Address - Street 2:SUITE #100
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89012-5724
Practice Address - Country:US
Practice Address - Phone:702-982-7100
Practice Address - Fax:702-982-7102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV12082208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV6727480001OtherPTAN
NV6727480001Medicare NSC
NV6727480001OtherPTAN