Provider Demographics
NPI:1376731992
Name:ORTHOMED PAIN RELIEF CENTERS, LLC
Entity Type:Organization
Organization Name:ORTHOMED PAIN RELIEF CENTERS, LLC
Other - Org Name:ORTHOMED PAIN & SPORTS MEDICINE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:J
Authorized Official - Last Name:COLE
Authorized Official - Suffix:JR
Authorized Official - Credentials:DO
Authorized Official - Phone:941-371-7171
Mailing Address - Street 1:4071 BEE RIDGE RD
Mailing Address - Street 2:SUITE 101
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34233-2550
Mailing Address - Country:US
Mailing Address - Phone:941-371-7171
Mailing Address - Fax:941-371-7474
Practice Address - Street 1:4071 BEE RIDGE RD
Practice Address - Street 2:SUITE 101
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34233-2550
Practice Address - Country:US
Practice Address - Phone:941-371-7171
Practice Address - Fax:941-371-7474
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-10-09
Last Update Date:2013-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS86972081P2900X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI43415Medicare UPIN
FL6186900001Medicare NSC
FLU6089ZMedicare PIN