Provider Demographics
NPI:1841363736
Name:CBCC PAIN MEDICINE AND SURGERY CENTER, INC
Entity type:Organization
Organization Name:CBCC PAIN MEDICINE AND SURGERY CENTER, INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:REVENUE CYCLE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:DIGISHA
Authorized Official - Middle Name:
Authorized Official - Last Name:MODI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:661-862-7105
Mailing Address - Street 1:6501 TRUXTUN AVE # 190
Mailing Address - Street 2:
Mailing Address - City:BAKERSFIELD
Mailing Address - State:CA
Mailing Address - Zip Code:93309-0633
Mailing Address - Country:US
Mailing Address - Phone:661-325-8498
Mailing Address - Fax:661-862-7137
Practice Address - Street 1:6501 TRUXTUN AVE # 190
Practice Address - Street 2:
Practice Address - City:BAKERSFIELD
Practice Address - State:CA
Practice Address - Zip Code:93309-0633
Practice Address - Country:US
Practice Address - Phone:661-325-8498
Practice Address - Fax:661-862-7137
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-16
Last Update Date:2023-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA0548691261QA1903X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA1903XAmbulatory Health Care FacilitiesClinic/CenterAmbulatory Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA=========OtherTAX IDENTIFICATION NUMBER
ZZZ15038ZMedicare PIN