Provider Demographics
NPI:1982953089
Name:NATURECOAST PAIN ASSOCIATES INC
Entity Type:Organization
Organization Name:NATURECOAST PAIN ASSOCIATES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTOPHER
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:FALLOWS
Authorized Official - Suffix:
Authorized Official - Credentials:DO
Authorized Official - Phone:352-527-4444
Mailing Address - Street 1:70 N LECANTO HWY
Mailing Address - Street 2:
Mailing Address - City:LECANTO
Mailing Address - State:FL
Mailing Address - Zip Code:34461-9190
Mailing Address - Country:US
Mailing Address - Phone:352-527-4444
Mailing Address - Fax:352-746-7829
Practice Address - Street 1:70 N LECANTO HWY
Practice Address - Street 2:
Practice Address - City:LECANTO
Practice Address - State:FL
Practice Address - Zip Code:34461-9190
Practice Address - Country:US
Practice Address - Phone:352-527-4444
Practice Address - Fax:352-746-7829
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-05
Last Update Date:2015-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS5879208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DT1184OtherRAILROAD MEDICARE
FL003QUOtherFLORIDA BLUE
FLGM283AOtherMEDICARE PTAN