Provider Demographics
NPI:1124541362
Name:PAIN MEDICAL CENTER CORP
Entity Type:Organization
Organization Name:PAIN MEDICAL CENTER CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:YNES
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:OMANA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-374-4754
Mailing Address - Street 1:1806 N FLAMINGO RD STE 450
Mailing Address - Street 2:
Mailing Address - City:PEMBROKE PINES
Mailing Address - State:FL
Mailing Address - Zip Code:33028-1043
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1806 N FLAMINGO RD STE 450
Practice Address - Street 2:
Practice Address - City:PEMBROKE PINES
Practice Address - State:FL
Practice Address - Zip Code:33028-1043
Practice Address - Country:US
Practice Address - Phone:954-374-4754
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-07-19
Last Update Date:2017-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical TherapistGroup - Multi-Specialty