Provider Demographics
NPI:1639583941
Name:COMPREHENSIVE PAIN SPECIALISTS
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN SPECIALISTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:DR
Authorized Official - First Name:REX
Authorized Official - Middle Name:BENNETT
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:601-540-8059
Mailing Address - Street 1:522 WILL DR
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6358
Mailing Address - Country:US
Mailing Address - Phone:662-588-0947
Mailing Address - Fax:
Practice Address - Street 1:120 STONE CREEK BLVD
Practice Address - Street 2:
Practice Address - City:FLOWOOD
Practice Address - State:MS
Practice Address - Zip Code:39232-8205
Practice Address - Country:US
Practice Address - Phone:601-420-2040
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-13
Last Update Date:2014-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain