Provider Demographics
NPI:1194001289
Name:JANE BISTLINE MD INTERVENTIONAL PAIN, LLC
Entity Type:Organization
Organization Name:JANE BISTLINE MD INTERVENTIONAL PAIN, LLC
Other - Org Name:INTERVENTIAL PAIN SERVICES OF PALM BEACH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:E
Authorized Official - Last Name:BISTLINE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-681-9808
Mailing Address - Street 1:2031 PALM BEACH LAKES BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33409-6501
Mailing Address - Country:US
Mailing Address - Phone:561-681-9808
Mailing Address - Fax:561-681-9989
Practice Address - Street 1:2031 PALM BEACH LAKES BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33409-6501
Practice Address - Country:US
Practice Address - Phone:561-681-9808
Practice Address - Fax:561-681-9989
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-02
Last Update Date:2011-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME64772208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F41321Medicare UPIN
FL23640BMedicare PIN