Provider Demographics
NPI:1477013688
Name:CENTER FOR PAIN TREATMENT
Entity Type:Organization
Organization Name:CENTER FOR PAIN TREATMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MAXI
Authorized Official - Middle Name:
Authorized Official - Last Name:MERCADO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-615-0784
Mailing Address - Street 1:989 SEBASTIAN BLVD UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SEBASTIAN
Mailing Address - State:FL
Mailing Address - Zip Code:32958-4879
Mailing Address - Country:US
Mailing Address - Phone:727-617-1777
Mailing Address - Fax:
Practice Address - Street 1:989 SEBASTIAN BLVD UNIT 3
Practice Address - Street 2:
Practice Address - City:SEBASTIAN
Practice Address - State:FL
Practice Address - Zip Code:32958-4879
Practice Address - Country:US
Practice Address - Phone:727-617-1777
Practice Address - Fax:888-836-2203
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-03-22
Last Update Date:2022-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLOL553OtherHF MEDICARE