Provider Demographics
NPI:1932426525
Name:WEST FLAGLER PAIN CARE CENTER INC
Entity Type:Organization
Organization Name:WEST FLAGLER PAIN CARE CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MELODY WEI
Authorized Official - Middle Name:CHYUN
Authorized Official - Last Name:CHUNG
Authorized Official - Suffix:
Authorized Official - Credentials:AP
Authorized Official - Phone:305-227-2485
Mailing Address - Street 1:8410 W FLAGLER ST
Mailing Address - Street 2:SUITE 208B
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33144-2092
Mailing Address - Country:US
Mailing Address - Phone:305-227-2485
Mailing Address - Fax:305-227-2596
Practice Address - Street 1:8410 W FLAGLER ST
Practice Address - Street 2:SUITE 208B
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33144-2092
Practice Address - Country:US
Practice Address - Phone:305-227-2485
Practice Address - Fax:305-227-2596
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 Licenses
StateLicense IDTaxonomies
FLAP123171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171100000XOther Service ProvidersAcupuncturistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL2196OtherHEALTH CARE CLINIC EXEMPTION