Provider Demographics
NPI:1811264328
Name:SUPERIOR PAIN SOLUTIONS
Entity type:Organization
Organization Name:SUPERIOR PAIN SOLUTIONS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:KILEY
Authorized Official - Middle Name:JOSEPH
Authorized Official - Last Name:REYNOLDS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:305-575-7246
Mailing Address - Street 1:8200 SW 117TH AVE
Mailing Address - Street 2:SUITE 312
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33183-3856
Mailing Address - Country:US
Mailing Address - Phone:305-575-7246
Mailing Address - Fax:305-575-7242
Practice Address - Street 1:8200 SW 117TH AVE
Practice Address - Street 2:SUITE 312
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33183-3856
Practice Address - Country:US
Practice Address - Phone:305-575-7246
Practice Address - Fax:305-575-7242
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-29
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS10004261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain