Provider Demographics
NPI:1891981528
Name:ATLANTIC SPINE & PAIN MANAGEMENT PA
Entity Type:Organization
Organization Name:ATLANTIC SPINE & PAIN MANAGEMENT PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:R
Authorized Official - Last Name:FREE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:386-615-2345
Mailing Address - Street 1:1425 HAND AVE STE L
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174-1136
Mailing Address - Country:US
Mailing Address - Phone:386-615-2345
Mailing Address - Fax:386-615-2366
Practice Address - Street 1:1425 HAND AVE STE L
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174-1136
Practice Address - Country:US
Practice Address - Phone:386-615-2345
Practice Address - Fax:386-615-2366
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-17
Last Update Date:2007-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty