Provider Demographics
NPI:1881040608
Name:ANESCO INTERVENTIONAL PAIN INSTITUTE, LLC
Entity Type:Organization
Organization Name:ANESCO INTERVENTIONAL PAIN INSTITUTE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VICE PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:
Authorized Official - Last Name:KOLBERT
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-703-2933
Mailing Address - Street 1:PO BOX 160805
Mailing Address - Street 2:
Mailing Address - City:ALTAMONTE SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:32716-0805
Mailing Address - Country:US
Mailing Address - Phone:954-580-4084
Mailing Address - Fax:954-580-4081
Practice Address - Street 1:4800 NE 20TH TER STE 303
Practice Address - Street 2:
Practice Address - City:FORT LAUDERDALE
Practice Address - State:FL
Practice Address - Zip Code:33308-4510
Practice Address - Country:US
Practice Address - Phone:954-580-4080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-11
Last Update Date:2021-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No332B00000XSuppliersDurable Medical Equipment & Medical SuppliesGroup - Single Specialty