MEDICARE: INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	367500000X	Certified Registered Nurse Anesthetist
2	207L00000X	Anesthesiology Physician
3	208VP0000X	Pain Medicine Physician
4	208VP0014X	Interventional Pain Medicine Physician
5	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	38751	OTHER	FL	BC/BS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1518941020
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC

Provider Business Mailing Address
First Line	:	PO BOX 744069
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	967 N UNIVERSITY DR
Second Line	:
City	:	CORAL SPRINGS
State	:	FL
Zip	:	33071-7048
Country	:	US
Telephone Number	:	954-341-5553
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	404-450-4684

Provider Enumeration Date	:	11/30/2005
Last Update Date	:	11/14/2023

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