Provider Demographics
NPI:1093993396
Name:COMPREHENSIVE PAIN CARE OF SOUTH FLORIDA
Entity Type:Organization
Organization Name:COMPREHENSIVE PAIN CARE OF SOUTH FLORIDA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:HOWELL
Authorized Official - Middle Name:
Authorized Official - Last Name:GOLDFARB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-795-8655
Mailing Address - Street 1:440 N STATE ROAD 7
Mailing Address - Street 2:SUITE 107
Mailing Address - City:ROYAL PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33411-3504
Mailing Address - Country:US
Mailing Address - Phone:561-795-8655
Mailing Address - Fax:561-795-8449
Practice Address - Street 1:440 N STATE ROAD 7
Practice Address - Street 2:SUITE 107
Practice Address - City:ROYAL PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33411-3504
Practice Address - Country:US
Practice Address - Phone:561-795-8655
Practice Address - Fax:561-795-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI 04148Medicare UPIN
FL34326Medicare PIN
FLE20440Medicare UPIN
FLD84708Medicare UPIN
FLH28740Medicare UPIN
FLH49446Medicare UPIN