Provider Demographics
NPI:1043606387
Name:PREMIER PAIN MANAGEMENT, PLLC
Entity Type:Organization
Organization Name:PREMIER PAIN MANAGEMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:DEBRA
Authorized Official - Last Name:VICTOR
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:973-698-7768
Mailing Address - Street 1:PO BOX 9161
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33075-9161
Mailing Address - Country:US
Mailing Address - Phone:973-698-7768
Mailing Address - Fax:
Practice Address - Street 1:3255 NW 94TH AVE
Practice Address - Street 2:SUITE 9161
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33075-2001
Practice Address - Country:US
Practice Address - Phone:973-698-7768
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-04-14
Last Update Date:2015-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME100973208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1164422705OtherNPI