Provider Demographics
NPI:1144383746
Name:OUCH, PA
Entity Type:Organization
Organization Name:OUCH, PA
Other - Org Name:PHYSICIANS PAIN CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JYOTI
Authorized Official - Middle Name:
Authorized Official - Last Name:PATEL
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-808-7246
Mailing Address - Street 1:105 SOUTHPARK BLVD
Mailing Address - Street 2:SUITE C 300
Mailing Address - City:ST AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32086-4162
Mailing Address - Country:US
Mailing Address - Phone:904-808-7246
Mailing Address - Fax:904-808-7090
Practice Address - Street 1:105 SOUTHPARK BLVD
Practice Address - Street 2:SUITE C 300
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-4162
Practice Address - Country:US
Practice Address - Phone:904-808-7246
Practice Address - Fax:904-808-7090
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-18
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7612385OtherAETNA
FL34189OtherBLUE CROSS BLUE SHIELD
34189Medicare ID - Type Unspecified