Provider Demographics
NPI:1639112469
Name:ADVANCED PAIN MANAGEMENT CENTER, INC.
Entity Type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MEDHAT
Authorized Official - Middle Name:ALLAM
Authorized Official - Last Name:REHEEM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-596-9200
Mailing Address - Street 1:12900 CORTEZ BLVD
Mailing Address - Street 2:SUITE 204
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-6828
Mailing Address - Country:US
Mailing Address - Phone:352-596-9200
Mailing Address - Fax:352-596-4019
Practice Address - Street 1:12900 CORTEZ BLVD
Practice Address - Street 2:SUITE 204
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-6828
Practice Address - Country:US
Practice Address - Phone:352-596-9200
Practice Address - Fax:352-596-4019
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-13
Last Update Date:2013-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0066757174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLK3086Medicare PIN