Provider Demographics
NPI:1407852262
Name:CENTRAL FLORIDA PAIN MANAGEMENT
Entity Type:Organization
Organization Name:CENTRAL FLORIDA PAIN MANAGEMENT
Other - Org Name:LIPSON PAIN INSTITUTE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANA
Authorized Official - Middle Name:D
Authorized Official - Last Name:LIPSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:863-293-4800
Mailing Address - Street 1:PO BOX 9442
Mailing Address - Street 2:
Mailing Address - City:WINTER HAVEN
Mailing Address - State:FL
Mailing Address - Zip Code:33883
Mailing Address - Country:US
Mailing Address - Phone:863-293-4800
Mailing Address - Fax:863-293-4410
Practice Address - Street 1:210 1ST STREET N
Practice Address - Street 2:
Practice Address - City:WINTER HAVEN
Practice Address - State:FL
Practice Address - Zip Code:33881
Practice Address - Country:US
Practice Address - Phone:863-293-4800
Practice Address - Fax:863-293-4410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-06-24
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0062738208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLEJ880AMedicare PIN
FLG20273Medicare UPIN