Organization
COMPREHENSIVE PAIN MANAGEMENT SPECIALISTS , LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
AMANDA RICCA (CEO)
(570) 270-5713
Entity
Organization
Contact information
Practice address
1177 HIGHWAY 315 BLVD, DOLPHIN PLAZA, WILKES BARRE, PA 18702-6928
(570) 270-5700
(570) 270-5719
Mailing address
1177 HIGHWAY 315 BLVD, DOLPHIN PLAZA, WILKES BARRE, PA 18702-6928
(570) 270-5713
(570) 270-5719
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1025631710001
—
PA
01
—
2576567
BLUE SHIELD
PA
Enumeration date
11/16/2010
Last updated
07/02/2025
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