Provider Demographics
NPI:1477668291
Name:PAIN MANAGEMENT CENTER OF NAPLES LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT CENTER OF NAPLES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PRATHIMA
Authorized Official - Middle Name:
Authorized Official - Last Name:MOORTHY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-593-9599
Mailing Address - Street 1:4760 TAMIAMI TRAIL N
Mailing Address - Street 2:STE 27
Mailing Address - City:NAPLES
Mailing Address - State:FL
Mailing Address - Zip Code:34103-3057
Mailing Address - Country:US
Mailing Address - Phone:239-593-9599
Mailing Address - Fax:239-593-4099
Practice Address - Street 1:4760 TAMIAMI TRL N STE 27
Practice Address - Street 2:
Practice Address - City:NAPLES
Practice Address - State:FL
Practice Address - Zip Code:34103-3057
Practice Address - Country:US
Practice Address - Phone:239-593-9599
Practice Address - Fax:239-593-4099
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2017-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 0567442081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
=========OtherTAX ID