MEDICARE: FREEDOM PAIN MANAGEMENT, LCC

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	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1457866782
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FREEDOM PAIN MANAGEMENT, LCC

Provider Business Mailing Address
First Line	:	8198 S JOG RD STE 100
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2998
Country	:	US
Telephone Number	:	561-602-6191
Fax Number	:

Provider Business Practice Location Address
First Line	:	8198 S JOG RD STE 100
Second Line	:
City	:	BOYNTON BEACH
State	:	FL
Zip	:	33472-2998
Country	:	US
Telephone Number	:	561-602-6191
Fax Number	:

Authorized Official
Title or Position	:	MGRM
Name	:	JOSEPH S GARONE
Credential	:	DC
Telephone Number	:	561-396-2552

Provider Enumeration Date	:	12/08/2017
Last Update Date	:	12/08/2017

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