Provider Demographics
NPI:1639333859
Name:PAIN MANAGEMENT INSTITUTE LLC
Entity Type:Organization
Organization Name:PAIN MANAGEMENT INSTITUTE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHAN
Authorized Official - Middle Name:JOSHUA
Authorized Official - Last Name:HANFLINK
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-357-0668
Mailing Address - Street 1:601 JENNINGS AVE
Mailing Address - Street 2:
Mailing Address - City:EUSTIS
Mailing Address - State:FL
Mailing Address - Zip Code:32726-6148
Mailing Address - Country:US
Mailing Address - Phone:352-357-0668
Mailing Address - Fax:352-357-3643
Practice Address - Street 1:601 JENNINGS AVE
Practice Address - Street 2:
Practice Address - City:EUSTIS
Practice Address - State:FL
Practice Address - Zip Code:32726-6148
Practice Address - Country:US
Practice Address - Phone:352-357-0668
Practice Address - Fax:352-357-3643
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-16
Last Update Date:2020-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS9725208VP0014X, 208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL004178500Medicaid
FL10D1088106OtherCLIA-CERTIFICATE OF WAIVER
FLDP7786OtherRAILROAD MEDICARE PTAN
FL1036842OtherNON-PHARMACY DISPENSING SITE
FLBH086OtherPTAN-GROUP
FLJR44088000OtherFL DOH-RADIATION MACHINE
FLPMC1328OtherFL DOH-PAIN MANAGEMENT CLINIC
FLDP7786OtherRAILROAD MEDICARE PTAN