Provider Demographics
NPI:1639164700
Name:COMPREHENSIVE SPINE CARE
Entity Type:Organization
Organization Name:COMPREHENSIVE SPINE CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:KAMAL
Authorized Official - Middle Name:KUMAR
Authorized Official - Last Name:TIWARI
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:812-333-7246
Mailing Address - Street 1:PO BOX 5637
Mailing Address - Street 2:ATTN: MARIA MITCHELL
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47407-5637
Mailing Address - Country:US
Mailing Address - Phone:812-824-5688
Mailing Address - Fax:812-824-5692
Practice Address - Street 1:2499 W COTA DR
Practice Address - Street 2:
Practice Address - City:BLOOMINGTON
Practice Address - State:IN
Practice Address - Zip Code:47403-4217
Practice Address - Country:US
Practice Address - Phone:812-337-0210
Practice Address - Fax:812-337-0211
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-15
Last Update Date:2007-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN50004448A261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN197850Medicare ID - Type UnspecifiedPHYSICIANS
IN198720Medicare ID - Type UnspecifiedPT'S
IN198780Medicare ID - Type UnspecifiedPSYCHOLOGISTS