Provider Demographics
NPI:1841591211
Name:COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS , PC
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS , PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:AMANDA
Authorized Official - Middle Name:
Authorized Official - Last Name:RICCA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:570-270-5713
Mailing Address - Street 1:1177 HIGHWAY 315 BLVD
Mailing Address - Street 2:DOLPHIN PLAZA
Mailing Address - City:WILKES BARRE
Mailing Address - State:PA
Mailing Address - Zip Code:18702-6928
Mailing Address - Country:US
Mailing Address - Phone:570-270-5713
Mailing Address - Fax:570-270-5719
Practice Address - Street 1:1177 HIGHWAY 315 BLVD
Practice Address - Street 2:DOLPHIN PLAZA
Practice Address - City:WILKES BARRE
Practice Address - State:PA
Practice Address - Zip Code:18702-6928
Practice Address - Country:US
Practice Address - Phone:570-270-5700
Practice Address - Fax:570-270-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-11-16
Last Update Date:2023-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA1025631710001Medicaid
PA2576567OtherBLUE SHIELD
PA1025631710001Medicaid