Provider Demographics
NPI:1881453777
Name:PALM BEACH PAIN MANAGEMENT SPECIALISTS
Entity type:Organization
Organization Name:PALM BEACH PAIN MANAGEMENT SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:SHANNEN
Authorized Official - Middle Name:
Authorized Official - Last Name:SEVERSEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-292-3747
Mailing Address - Street 1:907 N FEDERAL HWY
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33435-3224
Mailing Address - Country:US
Mailing Address - Phone:561-292-3747
Mailing Address - Fax:561-292-3730
Practice Address - Street 1:907 N FEDERAL HWY
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33435-3224
Practice Address - Country:US
Practice Address - Phone:561-292-3747
Practice Address - Fax:561-292-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-14
Last Update Date:2024-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty