1063858447 NPI number — THE PAIN INSTITUTE INC

Table of content: (NPI 1063858447)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1063858447 NPI number — THE PAIN INSTITUTE INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE PAIN INSTITUTE INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
FLORIDA PAIN
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1063858447
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
05/13/2013
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 562707
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKLEDGE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32956-2707
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
321-784-8211
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5545 N WICKHAM RD
Provider Second Line Business Practice Location Address:
SUITE 104
Provider Business Practice Location Address City Name:
MELBOURNE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32940-7323
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
321-784-8211
Provider Business Practice Location Address Fax Number:
321-775-0535
Provider Enumeration Date:
05/13/2013

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
GOLOVAC
Authorized Official First Name:
STANLEY
Authorized Official Middle Name:
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
321-394-9426

Provider Taxonomy Codes

  • Taxonomy code: 208VP0014X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)