Provider Demographics
NPI:1538462304
Name:LAKE WORTH PAIN CENTER, PA
Entity Type:Organization
Organization Name:LAKE WORTH PAIN CENTER, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHRISTINE
Authorized Official - Middle Name:A
Authorized Official - Last Name:KLEPP
Authorized Official - Suffix:
Authorized Official - Credentials:MD, PA
Authorized Official - Phone:561-333-8460
Mailing Address - Street 1:10115 FOREST HILL BLVD
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3105
Mailing Address - Country:US
Mailing Address - Phone:561-642-1219
Mailing Address - Fax:561-333-2899
Practice Address - Street 1:10115 FOREST HILL BLVD
Practice Address - Street 2:SUITE 102
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-6178
Practice Address - Country:US
Practice Address - Phone:561-333-8460
Practice Address - Fax:561-333-2899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-12-16
Last Update Date:2012-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME61467174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL14753BMedicare UPIN