Provider Demographics
NPI:1417316027
Name:AMERICAN INTERVENTIONAL PAIN INSTITUTE, CORP.
Entity Type:Organization
Organization Name:AMERICAN INTERVENTIONAL PAIN INSTITUTE, CORP.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:THELMA
Authorized Official - Middle Name:
Authorized Official - Last Name:RIVERA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-434-7577
Mailing Address - Street 1:4897 S JOG RD
Mailing Address - Street 2:SUITE A
Mailing Address - City:GREENACRES
Mailing Address - State:FL
Mailing Address - Zip Code:33467-5000
Mailing Address - Country:US
Mailing Address - Phone:561-880-8559
Mailing Address - Fax:561-828-8583
Practice Address - Street 1:4897 S JOG RD
Practice Address - Street 2:SUITE A
Practice Address - City:GREENACRES
Practice Address - State:FL
Practice Address - Zip Code:33467-5000
Practice Address - Country:US
Practice Address - Phone:561-641-0089
Practice Address - Fax:561-434-3440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-11
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0076064261QM2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL=========OtherEIN