Provider Demographics
NPI:1659031326
Name:ORLANDO PAIN CENTERS OF EXCELLENCE LLC
Entity Type:Organization
Organization Name:ORLANDO PAIN CENTERS OF EXCELLENCE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD
Authorized Official - Prefix:
Authorized Official - First Name:JOHN
Authorized Official - Middle Name:
Authorized Official - Last Name:GERNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-381-5699
Mailing Address - Street 1:515 W STATE ROAD 434 STE 201
Mailing Address - Street 2:
Mailing Address - City:LONGWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:32750-5162
Mailing Address - Country:US
Mailing Address - Phone:407-745-1115
Mailing Address - Fax:407-745-1005
Practice Address - Street 1:515 W STATE ROAD 434 STE 201
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5162
Practice Address - Country:US
Practice Address - Phone:407-745-1115
Practice Address - Fax:407-745-1005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-22
Last Update Date:2021-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207T00000XAllopathic & Osteopathic PhysiciansNeurological SurgeryGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty