Provider Demographics
NPI:1891463386
Name:PREMIER PAIN CARE OF FLORIDA, INC
Entity Type:Organization
Organization Name:PREMIER PAIN CARE OF FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MIKHAIL
Authorized Official - Middle Name:
Authorized Official - Last Name:ARTAMONOV
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:570-872-9800
Mailing Address - Street 1:231 FRIEMANN LANE
Mailing Address - Street 2:
Mailing Address - City:SCIOTA
Mailing Address - State:PA
Mailing Address - Zip Code:18354
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:701 SE 6TH AVE
Practice Address - Street 2:
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33483-5186
Practice Address - Country:US
Practice Address - Phone:570-872-9800
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-08-31
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME100837OtherMEDICAL LICENSE
FLME100837OtherMEDICAL LICENSE