Provider Demographics
NPI:1891018933
Name:PAIN FACILITY MANAGEMENT LLC
Entity Type:Organization
Organization Name:PAIN FACILITY MANAGEMENT LLC
Other - Org Name:INDUSTRIAL MEDICINE SPECIALISTS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:MIRE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:504-887-7207
Mailing Address - Street 1:3348 W ESPLANADE AVE S
Mailing Address - Street 2:SUITE A
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-3475
Mailing Address - Country:US
Mailing Address - Phone:504-887-7207
Mailing Address - Fax:504-889-1868
Practice Address - Street 1:1849 BARATARIA BLVD
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-4203
Practice Address - Country:US
Practice Address - Phone:504-207-7555
Practice Address - Fax:504-207-7556
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-03
Last Update Date:2013-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207P00000XAllopathic & Osteopathic PhysiciansEmergency MedicineGroup - Multi-Specialty
No208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationGroup - Multi-Specialty