Provider Demographics
NPI:1780036632
Name:INTERVENTIONAL PAIN CLINICS LLC
Entity Type:Organization
Organization Name:INTERVENTIONAL PAIN CLINICS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER; MD
Authorized Official - Prefix:
Authorized Official - First Name:RICHARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:LEANO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-248-1166
Mailing Address - Street 1:3401 PGA BLVD
Mailing Address - Street 2:SUITE 225
Mailing Address - City:PALM BEACH GARDENS
Mailing Address - State:FL
Mailing Address - Zip Code:33410-2823
Mailing Address - Country:US
Mailing Address - Phone:561-248-1166
Mailing Address - Fax:845-913-1263
Practice Address - Street 1:3401 PGA BLVD
Practice Address - Street 2:SUITE 225
Practice Address - City:PALM BEACH GARDENS
Practice Address - State:FL
Practice Address - Zip Code:33410-2823
Practice Address - Country:US
Practice Address - Phone:561-248-1166
Practice Address - Fax:845-913-1263
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-04
Last Update Date:2016-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty