Basic Information
| Provider Information | |||||||||
| NPI: | 1548418320 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | COMPREHENSIVE PAIN MANAGEMENT LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2089 SOUTH RIDGE DRIVE | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624070801 | ||||||||
| FaxNumber: | 6624070807 | ||||||||
| Practice Location | |||||||||
| Address1: | 2089 SOUTH RIDGE DR. | ||||||||
| Address2: | |||||||||
| City: | TUPELO | ||||||||
| State: | MS | ||||||||
| PostalCode: | 388016478 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6624070801 | ||||||||
| FaxNumber: | 6624070807 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/04/2008 | ||||||||
| LastUpdateDate: | 10/15/2012 | ||||||||
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| AuthorizedOfficialLastName: | HAMMITT | ||||||||
| AuthorizedOfficialFirstName: | GEORGE | ||||||||
| AuthorizedOfficialMiddleName: | M | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 6624070801 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
| AuthorizedOfficialNameSuffix: | III | ||||||||
| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QA1903X | Y | Ambulatory Health Care Facilities | Clinic/Center | Ambulatory Surgical |
No ID Information.