Provider Demographics
NPI:1184854960
Name:ADVANCED CARE PAIN MANAGEMENT CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED CARE PAIN MANAGEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DARSHAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SHAH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-461-1008
Mailing Address - Street 1:2339 S US HIGHWAY 1
Mailing Address - Street 2:
Mailing Address - City:FORT PIERCE
Mailing Address - State:FL
Mailing Address - Zip Code:34982-5920
Mailing Address - Country:US
Mailing Address - Phone:772-461-1008
Mailing Address - Fax:772-461-0041
Practice Address - Street 1:2339 S US HIGHWAY 1
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-5920
Practice Address - Country:US
Practice Address - Phone:772-461-1008
Practice Address - Fax:772-461-0041
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-07-15
Last Update Date:2010-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME47071174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty