Provider Demographics
NPI:1043204415
Name:FLORIDA PAIN CLINIC, INC
Entity Type:Organization
Organization Name:FLORIDA PAIN CLINIC, INC
Other - Org Name:FLORIDA PAIN CLINIC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:T
Authorized Official - Last Name:PYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-873-6808
Mailing Address - Street 1:PO BOX 1626
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34478-1626
Mailing Address - Country:US
Mailing Address - Phone:352-873-6808
Mailing Address - Fax:352-873-6808
Practice Address - Street 1:2300 S PINE AVE
Practice Address - Street 2:SUITE B
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34471-5102
Practice Address - Country:US
Practice Address - Phone:352-861-4600
Practice Address - Fax:352-237-5437
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-08-31
Last Update Date:2014-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL62484OtherBCBS
FL62484OtherBCBS