Basic Information
| Provider Information | |||||||||
| NPI: | 1417327792 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE CARE MEDICAL ASSOCIATES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1205 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157411963 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Practice Location | |||||||||
| Address1: | 1205 LANGHORNE NEWTOWN RD | ||||||||
| Address2: | SUITE 309 | ||||||||
| City: | LANGHORNE | ||||||||
| State: | PA | ||||||||
| PostalCode: | 190471219 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2157411963 | ||||||||
| FaxNumber: | 6092617199 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 09/30/2015 | ||||||||
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| AuthorizedOfficialLastName: | BOWEN | ||||||||
| AuthorizedOfficialFirstName: | JO | ||||||||
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| AuthorizedOfficialTitleorPosition: | BILLING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 6092615755 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | CPC, CPC-I, CGIC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 364SG0600X | SP015271 | PA | Y | 193400000X SINGLE SPECIALTY GROUP | Physician Assistants & Advanced Practice Nursing Providers | Clinical Nurse Specialist | Gerontology |
No ID Information.