Organization
COMPREHENSIVE PAIN REHAB OF SOUTHERN INDIANA LLC
Active
Other names
Pain Management Surgery Center
Organization subpart
No
Provider details
NPI number
Authorized official
DERK FRASIER (OWNER)
(812) 333-7246
Entity
Organization
Contact information
Practice address
2920 MCINTIRE DRIVE, SUITE 150B, BLOOMINGTON, IN 47403-4213
(812) 333-7246
(812) 333-4471
Mailing address
2920 MCINTIRE DRIVE, SUITE 150B, BLOOMINGTON, IN 47403-4213
(812) 333-7246
(812) 333-4471
Taxonomy
Speciality
Code
Description
License number
State
207L00000X
Anesthesiology Physician
—
IN
208VP0000X
Pain Medicine Physician
Primary
—
IN
363L00000X
Nurse Practitioner
—
IN
363LF0000X
Family Nurse Practitioner
—
IN
Other
Enumeration date
09/08/2010
Last updated
09/08/2010
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