Provider Demographics
NPI:1962816231
Name:ADVANCED PAIN MEDICINE OF NORTH FLORIDA LLC
Entity Type:Organization
Organization Name:ADVANCED PAIN MEDICINE OF NORTH FLORIDA LLC
Other - Org Name:ADVANCED PAIN MEDICAL CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENT
Authorized Official - Middle Name:T
Authorized Official - Last Name:STEWART
Authorized Official - Suffix:
Authorized Official - Credentials:MD, MBA
Authorized Official - Phone:352-508-8668
Mailing Address - Street 1:194 NW 137TH DRIVE
Mailing Address - Street 2:SUITE 100
Mailing Address - City:NEWBERRY
Mailing Address - State:FL
Mailing Address - Zip Code:32669
Mailing Address - Country:US
Mailing Address - Phone:352-508-8668
Mailing Address - Fax:352-433-4558
Practice Address - Street 1:194 NW 137TH DRIVE
Practice Address - Street 2:SUITE 100
Practice Address - City:NEWBERRY
Practice Address - State:FL
Practice Address - Zip Code:32669
Practice Address - Country:US
Practice Address - Phone:352-508-8668
Practice Address - Fax:352-433-4558
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-06-16
Last Update Date:2015-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME89103207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLHW493AMedicare PIN