Healthcare Provider Details

I. General information

NPI: 1629093596
Provider Name (Legal Business Name): PALM BEACH PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 11/30/2023
Certification Date: 11/30/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PALM BEACH PAIN MANAGEMENT 907 N. FEDERAL HWY
BOYNTON BEACH FL
33435
US

IV. Provider business mailing address

PALM BEACH PAIN MANAGEMENT 907 NORTH FEDERAL HWY
BOYNTON BEACH FL
33435
US

V. Phone/Fax

Practice location:
  • Phone: 561-292-3747
  • Fax: 561-292-3730
Mailing address:
  • Phone: 772-335-7246
  • Fax: 772-335-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DARLENE VANCE
Title or Position: PRACTICE ADMINISTRATOR
Credential:
Phone: 772-335-7246