Provider Demographics
NPI:1992456651
Name:COMMONWEALTH PAIN ASSOCIATES PLLC
Entity type:Organization
Organization Name:COMMONWEALTH PAIN ASSOCIATES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:BRANDON
Authorized Official - Middle Name:
Authorized Official - Last Name:GISH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:502-855-7200
Mailing Address - Street 1:101 PROSPEROUS PL STE 300
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40509-1836
Mailing Address - Country:US
Mailing Address - Phone:859-275-5229
Mailing Address - Fax:859-977-2683
Practice Address - Street 1:101 PROSPEROUS PL STE 300
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40509-1836
Practice Address - Country:US
Practice Address - Phone:859-275-5229
Practice Address - Fax:859-977-2683
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty