1407852262 NPI number — CENTRAL FLORIDA PAIN MANAGEMENT

Table of content: (NPI 1407852262)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1407852262 NPI number — CENTRAL FLORIDA PAIN MANAGEMENT

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTRAL FLORIDA PAIN MANAGEMENT
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:
LIPSON PAIN INSTITUTE
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:
1407852262
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/29/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 9442
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WINTER HAVEN
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
863-293-4800
Provider Business Mailing Address Fax Number:
863-293-4410

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
210 1ST STREET N
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WINTER HAVEN
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33881
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
863-293-4800
Provider Business Practice Location Address Fax Number:
863-293-4410
Provider Enumeration Date:
06/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
LIPSON
Authorized Official First Name:
ANA
Authorized Official Middle Name:
D
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
863-293-4800

Provider Taxonomy Codes

  • Taxonomy code: 208VP0000X , with the licence number:  ME0062738 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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