Provider Demographics
NPI:1326429739
Name:PIONEER PAIN MANAGEMENT INC
Entity Type:Organization
Organization Name:PIONEER PAIN MANAGEMENT INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTONIO
Authorized Official - Middle Name:
Authorized Official - Last Name:POTO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:772-446-4883
Mailing Address - Street 1:266 NW PEACOCK BLVD STE 205
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-2271
Mailing Address - Country:US
Mailing Address - Phone:772-446-4883
Mailing Address - Fax:772-446-4875
Practice Address - Street 1:8491 S FEDERAL HWY
Practice Address - Street 2:SUITE 15
Practice Address - City:PORT ST LUCIE
Practice Address - State:FL
Practice Address - Zip Code:34952-3360
Practice Address - Country:US
Practice Address - Phone:772-324-8214
Practice Address - Fax:772-324-8136
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-11
Last Update Date:2017-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty