COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, S.C.; NPI #1770846776

Contact Information

COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, S.C.

100 THEDA CLARK MEDICAL PLZ
SUITE 252
NEENAH, WI 54956-2763

Phone: 920-733-7230
Fax: 920-729-0347
Website:

Specialty	Taxonomy Code	Specialty Code	Provider Type
Interventional Pain Medicine	208VP0014X	09	Physician/Interventional Pain Management
Durable Medical Equipment & Medical Supplies	332B00000X	54	Other Medical Supply Company
Pain Medicine	207LP2900X	05	Physician/Anesthesiology

Indicates primary specialty

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NPI Profile & details for COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, S.C.

NPI Number 1770846776

LBN Legal business name COMPREHENSIVE PAIN MANAGEMENT OF THE FOX VALLEY, S.C.

Authorized official ALEXANDER YAKOVLEV - (PRESIDENT)

Entity Organization

Organization subpart ¹ No

Enumeration date 06/25/2012

Last updated 01/24/2013 - About 13 years ago

Identifiers

WI	License #	36140-20
WI	Medicaid	34086400

¹ Some organization health care providers are made up of components that furnish different types of health care or have separate physical locations where health care is furnished. These components and physical locations are not themselves legal entities, but are part of the organization health care provider (which is a legal entity). A covered organization provider may decide that its subparts (if it has any) should have their own NPI numbers. If a subpart conducts any HIPAA standard transactions on its own (e.g., separately from its parent), it must obtain its own NPI number.

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