Provider Demographics
NPI:1780630459
Name:PAIN MANAGEMENT AND SPINE CARE CENTER PA
Entity Type:Organization
Organization Name:PAIN MANAGEMENT AND SPINE CARE CENTER PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:EYAD
Authorized Official - Middle Name:
Authorized Official - Last Name:ALSABBAGH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:352-597-7184
Mailing Address - Street 1:12148 CORTEZ BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:34613-5575
Mailing Address - Country:US
Mailing Address - Phone:352-597-7184
Mailing Address - Fax:352-597-7186
Practice Address - Street 1:12148 CORTEZ BLVD
Practice Address - Street 2:
Practice Address - City:BROOKSVILLE
Practice Address - State:FL
Practice Address - Zip Code:34613-5575
Practice Address - Country:US
Practice Address - Phone:352-597-7184
Practice Address - Fax:352-597-7186
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-25
Last Update Date:2018-05-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081P2900X
FLME88499208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL277666900Medicaid
DF0703OtherRAILROAD MEDICARE
DF0703OtherRAILROAD MEDICARE