Provider Demographics
NPI:1932423563
Name:FIRST COAST PAIN MANAGEMENT
Entity Type:Organization
Organization Name:FIRST COAST PAIN MANAGEMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:ADKISON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-819-4478
Mailing Address - Street 1:P.O. BOX 830941
Mailing Address - Street 2:MSC#552
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35283-0941
Mailing Address - Country:US
Mailing Address - Phone:866-480-2246
Mailing Address - Fax:
Practice Address - Street 1:100 WHETSTONE PL STE 310
Practice Address - Street 2:
Practice Address - City:ST AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32086-5775
Practice Address - Country:US
Practice Address - Phone:904-819-4478
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-25
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME97111207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty