Provider Demographics
NPI:1881659704
Name:COMPREHENSIVE PAIN MEDICINE, INC.
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN MEDICINE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:RUBEN
Authorized Official - Middle Name:BERROCAL
Authorized Official - Last Name:TIMMONS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-968-9804
Mailing Address - Street 1:510 CORDAY ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32503-2021
Mailing Address - Country:US
Mailing Address - Phone:850-969-9804
Mailing Address - Fax:850-475-1472
Practice Address - Street 1:510 CORDAY ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32503-2021
Practice Address - Country:US
Practice Address - Phone:850-969-9804
Practice Address - Fax:850-475-1472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-04-20
Last Update Date:2009-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL372440900Medicaid
FL39810OtherBCBS GROUP NUMBER
AL529600860Medicaid
AL529600860Medicaid