Provider Demographics
NPI:1093038937
Name:PEARL MEDICAL PAIN CENTERS, LLC
Entity Type:Organization
Organization Name:PEARL MEDICAL PAIN CENTERS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:VILLE
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:321-773-2663
Mailing Address - Street 1:155 JACKSON AVE
Mailing Address - Street 2:
Mailing Address - City:SATELLITE BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32937-2993
Mailing Address - Country:US
Mailing Address - Phone:321-773-2663
Mailing Address - Fax:
Practice Address - Street 1:155 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SATELLITE BEACH
Practice Address - State:FL
Practice Address - Zip Code:32937-2993
Practice Address - Country:US
Practice Address - Phone:321-773-2663
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-07
Last Update Date:2010-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH3794111NX0800X
FLME36928207X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes111NX0800XChiropractic ProvidersChiropractorOrthopedicGroup - Multi-Specialty
No207X00000XAllopathic & Osteopathic PhysiciansOrthopaedic SurgeryGroup - Multi-Specialty