Provider Demographics
NPI:1851411474
Name:OKALOOSA PAIN CONSULTANTS P A
Entity Type:Organization
Organization Name:OKALOOSA PAIN CONSULTANTS P A
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:JANA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:850-689-8004
Mailing Address - Street 1:150 E REDSTONE AVE
Mailing Address - Street 2:SUITE A
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32539-5357
Mailing Address - Country:US
Mailing Address - Phone:850-689-8004
Mailing Address - Fax:850-689-8086
Practice Address - Street 1:150 E REDSTONE AVE
Practice Address - Street 2:SUITE A
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32539-5357
Practice Address - Country:US
Practice Address - Phone:850-689-8004
Practice Address - Fax:850-689-8086
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-29
Last Update Date:2009-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty