MEDICARE: JOINT PAIN SOLUTION CENTER LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	207R00000X	Internal Medicine Physician

General Provider Information

NPI Number	:	1184496572
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	JOINT PAIN SOLUTION CENTER LLC

Provider Business Mailing Address
First Line	:	6294 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1917
Country	:	US
Telephone Number	:	443-762-0234
Fax Number	:	954-363-9080

Provider Business Practice Location Address
First Line	:	6294 N FEDERAL HWY
Second Line	:
City	:	FORT LAUDERDALE
State	:	FL
Zip	:	33308-1917
Country	:	US
Telephone Number	:	443-762-0234
Fax Number	:	954-363-9080

Authorized Official
Title or Position	:	MD
Name	:	JEFF BROWN
Credential	:
Telephone Number	:	443-762-0234

Provider Enumeration Date	:	10/27/2023
Last Update Date	:	10/27/2023

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