Provider Demographics
NPI:1184165862
Name:COMPASSIONATE HEALTH AND MANAGED PAIN LLC
Entity type:Organization
Organization Name:COMPASSIONATE HEALTH AND MANAGED PAIN LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TISH
Authorized Official - Middle Name:J
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:386-944-9813
Mailing Address - Street 1:570 MEMORIAL CIR
Mailing Address - Street 2:SUITE 200
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-5002
Mailing Address - Country:US
Mailing Address - Phone:386-451-2346
Mailing Address - Fax:
Practice Address - Street 1:570 MEMORIAL CIR
Practice Address - Street 2:SUITE 200
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-5002
Practice Address - Country:US
Practice Address - Phone:386-451-2346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-15
Last Update Date:2024-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ME1019682084A0401X
FLME1019682084N0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084N0400XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyNeurologyGroup - Multi-Specialty
No2084A0401XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyAddiction MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI15939Medicare UPIN
FLAR609ZMedicare Oscar/Certification