Provider Demographics
NPI:1295196459
Name:CENTER FOR ADDICTION AND PAIN MANAGEMENT, LLC.
Entity Type:Organization
Organization Name:CENTER FOR ADDICTION AND PAIN MANAGEMENT, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:OBED
Authorized Official - Middle Name:
Authorized Official - Last Name:SAINT-LOUIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:772-663-2492
Mailing Address - Street 1:235 CITRUS TOWER BOULEVARD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34711
Mailing Address - Country:US
Mailing Address - Phone:352-404-8160
Mailing Address - Fax:352-404-8560
Practice Address - Street 1:235 CITRUS TOWER BOULEVARD
Practice Address - Street 2:SUITE 104
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711
Practice Address - Country:US
Practice Address - Phone:352-404-8160
Practice Address - Fax:352-404-8560
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-03-16
Last Update Date:2018-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 126938261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016932800Medicaid
FLIO604AMedicare UPIN