Provider Demographics
NPI:1417141995
Name:COMPREHENSIVE PAIN MEDICINE CENTER
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MEDICINE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:GUZAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-809-9888
Mailing Address - Street 1:67230 INDUSTRY LN
Mailing Address - Street 2:STE 2
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-8704
Mailing Address - Country:US
Mailing Address - Phone:985-801-6285
Mailing Address - Fax:985-801-6269
Practice Address - Street 1:67230 INDUSTRY LN
Practice Address - Street 2:STE 2
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-8704
Practice Address - Country:US
Practice Address - Phone:985-801-6285
Practice Address - Fax:985-801-6269
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAIRWAY MEDICAL CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-08-28
Last Update Date:2007-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA556174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty