Provider Demographics
NPI:1073544169
Name:STOP PAIN MEDICAL CENTER, INC.
Entity Type:Organization
Organization Name:STOP PAIN MEDICAL CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:M
Authorized Official - Last Name:RODRIGUEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:305-646-0120
Mailing Address - Street 1:525 NW 27TH AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33125-3043
Mailing Address - Country:US
Mailing Address - Phone:305-646-0120
Mailing Address - Fax:305-646-0119
Practice Address - Street 1:525 NW 27TH AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33125-3043
Practice Address - Country:US
Practice Address - Phone:305-646-0120
Practice Address - Fax:305-646-0119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-06
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC3929174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC3929OtherHEALT CARE CLINIC LICENSE
FL=========OtherTAX ID NUMBER