Provider Demographics
NPI:1679883656
Name:FULL SERVICE PAIN MANAGEMENT
Entity Type:Organization
Organization Name:FULL SERVICE PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:EDUARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:MILA PRATS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-987-6100
Mailing Address - Street 1:3107 W. HALLANDALE BEACH BLVD
Mailing Address - Street 2:SUITE #102
Mailing Address - City:PEMBROKE PARK
Mailing Address - State:FL
Mailing Address - Zip Code:33009-5144
Mailing Address - Country:US
Mailing Address - Phone:954-987-6100
Mailing Address - Fax:954-987-2360
Practice Address - Street 1:3107 W. HALLANDALE BEACH BLVD
Practice Address - Street 2:SUITE #102
Practice Address - City:PEMBROKE PARK
Practice Address - State:FL
Practice Address - Zip Code:33009-5144
Practice Address - Country:US
Practice Address - Phone:954-987-6100
Practice Address - Fax:954-987-2360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-08
Last Update Date:2010-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMC541261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain