Provider Demographics
NPI:1639103674
Name:COMPREHENSIVE PAIN MANAGEMENT, PA
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANN
Authorized Official - Middle Name:T
Authorized Official - Last Name:POTTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:361-882-4452
Mailing Address - Street 1:3201 AIRLINE RD STE K
Mailing Address - Street 2:
Mailing Address - City:CORPUS CHRISTI
Mailing Address - State:TX
Mailing Address - Zip Code:78414-3571
Mailing Address - Country:US
Mailing Address - Phone:361-882-4452
Mailing Address - Fax:361-882-5414
Practice Address - Street 1:3201 AIRLINE RD STE K
Practice Address - Street 2:
Practice Address - City:CORPUS CHRISTI
Practice Address - State:TX
Practice Address - Zip Code:78414-3571
Practice Address - Country:US
Practice Address - Phone:361-882-4452
Practice Address - Fax:361-882-5414
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-10
Last Update Date:2022-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX6386100001Medicare NSC