1437248150 NPI number — ADVANCED PAIN MANAGEMENT SPECIALISTS

Table of content: (NPI 1437248150)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437248150 NPI number — ADVANCED PAIN MANAGEMENT SPECIALISTS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCED PAIN MANAGEMENT SPECIALISTS
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:
Provider Other Organization Name Type Code:
6
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:
1437248150
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 07400
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FORT MYERS
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33919-0400
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
239-437-8000
Provider Business Mailing Address Fax Number:
239-437-9991

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1425 VISCAYA PKWY
Provider Second Line Business Practice Location Address:
SUITE 202
Provider Business Practice Location Address City Name:
CAPE CORAL
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
33990-3294
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
239-574-1464
Provider Business Practice Location Address Fax Number:
239-574-1286
Provider Enumeration Date:
10/12/2006

Additional Information

Authorized Official

Authorized Official Last Name:
DAITCH
Authorized Official First Name:
JONATHAN
Authorized Official Middle Name:
S.
Authorized Official Title or Position:
PARTNER
Authorized Official Telephone Number:
239-437-8002

Provider Taxonomy Codes

  • Taxonomy code: 207LP2900X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 7926233 . This is a "AETNA GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: 74588 . This is a "BCBS/FL GROUP NUMBER" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".
  • Identifier: CH8338 . This is a "RAILROAD MEDICARE GROUP #" identifier , issued by the state of ( FL ) . This identifiers is of the category "OTHER".




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