Provider Demographics
NPI:1518276633
Name:SOUTHEAST FLORIDA PAIN MANAGEMENT LLC
Entity Type:Organization
Organization Name:SOUTHEAST FLORIDA PAIN MANAGEMENT LLC
Other - Org Name:PALM BEACH PAIN & URGENT CARE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:M
Authorized Official - Last Name:CARPENTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-661-7580
Mailing Address - Street 1:517 NORTHLAKE BLVD
Mailing Address - Street 2:
Mailing Address - City:NORTH PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33408-5408
Mailing Address - Country:US
Mailing Address - Phone:561-844-4400
Mailing Address - Fax:561-844-7444
Practice Address - Street 1:517 NORTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:NORTH PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33408-5408
Practice Address - Country:US
Practice Address - Phone:561-844-4400
Practice Address - Fax:561-844-7444
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SOUTHEAST FLORIDA PAIN MANAGMENT LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2010-10-07
Last Update Date:2010-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8586208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty