Provider Demographics
NPI:1891148250
Name:RESTORE MEDICAL PARTNERS, PLLC
Entity Type:Organization
Organization Name:RESTORE MEDICAL PARTNERS, PLLC
Other - Org Name:RESTORE MEDICAL PARTNERS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LINDSEY
Authorized Official - Middle Name:T
Authorized Official - Last Name:JOB
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:615-517-2162
Mailing Address - Street 1:333 S. TAMIAMI TRL
Mailing Address - Street 2:SUITE 169/171
Mailing Address - City:VENICE
Mailing Address - State:FL
Mailing Address - Zip Code:34285-2402
Mailing Address - Country:US
Mailing Address - Phone:941-375-3006
Mailing Address - Fax:941-218-4825
Practice Address - Street 1:333 S TAMIAMI TRL
Practice Address - Street 2:SUITE 169/171
Practice Address - City:VENICE
Practice Address - State:FL
Practice Address - Zip Code:34285-2402
Practice Address - Country:US
Practice Address - Phone:941-375-3006
Practice Address - Fax:941-218-4825
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-07-20
Last Update Date:2016-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME 119800207L00000X, 207LP2900X, 208VP0014X
FLFJ2955740208VP0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Multi-Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Multi-Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME119800OtherSTATE LICENSE
FLIA713ZMedicare UPIN