Provider Demographics
NPI:1295052884
Name:THE PAIN INSTITUTE
Entity type:Organization
Organization Name:THE PAIN INSTITUTE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:
Authorized Official - Last Name:GAYLES
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:321-784-8211
Mailing Address - Street 1:PO BOX 562707
Mailing Address - Street 2:
Mailing Address - City:ROCKLEDGE
Mailing Address - State:FL
Mailing Address - Zip Code:32956-2707
Mailing Address - Country:US
Mailing Address - Phone:321-784-8211
Mailing Address - Fax:321-394-9425
Practice Address - Street 1:595 N COURTENAY PKWY
Practice Address - Street 2:
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-4851
Practice Address - Country:US
Practice Address - Phone:321-784-8211
Practice Address - Fax:321-394-9425
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site