Provider Demographics
NPI:1295002863
Name:JUPITER PAIN MANAGEMENT CONSULTANTS
Entity type:Organization
Organization Name:JUPITER PAIN MANAGEMENT CONSULTANTS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:NATHANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DROURR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-262-5137
Mailing Address - Street 1:75 RIVER DR
Mailing Address - Street 2:
Mailing Address - City:TEQUESTA
Mailing Address - State:FL
Mailing Address - Zip Code:33469-1950
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2151 S ALTERNATE A1A
Practice Address - Street 2:SUITE 950
Practice Address - City:JUPITER
Practice Address - State:FL
Practice Address - Zip Code:33477-4112
Practice Address - Country:US
Practice Address - Phone:561-743-2239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-25
Last Update Date:2011-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72880207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL047364200Medicaid
FL253301400Medicaid
FLC99366Medicare UPIN
FL253301400Medicaid