Provider Demographics
NPI:1538498761
Name:POMPANO BEACH MEDICAL CORPORATION
Entity Type:Organization
Organization Name:POMPANO BEACH MEDICAL CORPORATION
Other - Org Name:PAIN MANAGEMENT INCORPORATED
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:DR
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:EDSON
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:954-573-5083
Mailing Address - Street 1:553 EAST SAMPLE ROAD
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33064
Mailing Address - Country:US
Mailing Address - Phone:954-573-5083
Mailing Address - Fax:954-783-1080
Practice Address - Street 1:553 EAST SAMPLE ROAD
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33064
Practice Address - Country:US
Practice Address - Phone:954-573-5083
Practice Address - Fax:954-783-1080
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-17
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Single Specialty