Provider Demographics
NPI:1558464941
Name:AMERICAN PAIN MANAGEMENT CENTER INC
Entity Type:Organization
Organization Name:AMERICAN PAIN MANAGEMENT CENTER INC
Other - Org Name:AMERICAN PAIN MANAGEMENT
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:SCOTT
Authorized Official - Middle Name:
Authorized Official - Last Name:NOVICK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-726-4448
Mailing Address - Street 1:7710 NW 71ST CT
Mailing Address - Street 2:SUITE 202
Mailing Address - City:TAMARAC
Mailing Address - State:FL
Mailing Address - Zip Code:33321-2973
Mailing Address - Country:US
Mailing Address - Phone:954-726-4448
Mailing Address - Fax:954-726-5472
Practice Address - Street 1:7710 NW 71ST CT
Practice Address - Street 2:SUITE 202
Practice Address - City:TAMARAC
Practice Address - State:FL
Practice Address - Zip Code:33321-2973
Practice Address - Country:US
Practice Address - Phone:954-726-4448
Practice Address - Fax:954-726-5472
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-07
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174400000X
FLHCC5312332900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
No332900000XSuppliersNon-Pharmacy Dispensing SiteGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHCC5312OtherFLORIDA CLINIC LICENSE
FL1018236OtherNCPDP
FLHCC5312OtherFLORIDA CLINIC LICENSE