Provider Demographics
NPI:1114193927
Name:THE PAIN AND SPINE INSTITUTE, INC
Entity Type:Organization
Organization Name:THE PAIN AND SPINE INSTITUTE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHYSICIAN
Authorized Official - Prefix:
Authorized Official - First Name:DANNELL
Authorized Official - Middle Name:BOSSERMAN
Authorized Official - Last Name:ANSCHUETZ
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:561-996-4242
Mailing Address - Street 1:1100 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELLE GLADE
Mailing Address - State:FL
Mailing Address - Zip Code:33430-4910
Mailing Address - Country:US
Mailing Address - Phone:561-996-4242
Mailing Address - Fax:
Practice Address - Street 1:1100 S MAIN ST
Practice Address - Street 2:
Practice Address - City:BELLE GLADE
Practice Address - State:FL
Practice Address - Zip Code:33430-4910
Practice Address - Country:US
Practice Address - Phone:561-996-4242
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-01
Last Update Date:2008-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL89322081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty