Organization
COMMONWEALTH PAIN SPECIALISTS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TAMIA FISHER (CREDENTIALING SPECIALIST)
(812) 962-7894
Entity
Organization
Contact information
Practice address
279 KINGS DAUGHTERS DR, SUITE 100, FRANKFORT, KY 40601
(502) 352-2530
(502) 352-2534
Mailing address
7145 E VIRGINIA ST STE 2000, EVANSVILLE, IN 47715-9147
(812) 962-7890
(812) 476-6162
Taxonomy
Speciality
Code
Description
License number
State
207LP2900X
Pain Medicine (Anesthesiology) Physician
Primary
—
—
332B00000X
Durable Medical Equipment & Medical Supplies
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
7100291160
—
KY
Enumeration date
10/19/2011
Last updated
10/07/2019
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