Healthcare Provider Details

I. General information

NPI: 1558399287
Provider Name (Legal Business Name): PAIN MANAGEMENT AND INTERVENTIONAL NERVE BLOCK SPECIATLISTS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/29/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2401 FRIST BLVD STE 7
FORT PIERCE FL
34950-4800
US

IV. Provider business mailing address

PO BOX 14657
CLEARWATER FL
33766-4657
US

V. Phone/Fax

Practice location:
  • Phone: 727-797-6768
  • Fax: 727-797-7648
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code2084P2900X
TaxonomyPain Medicine (Psychiatry & Neurology) Physician
License Number
License Number State

VIII. Authorized Official

Name: SCOTT KATZMAN
Title or Position: OWNER
Credential: M.D.
Phone: 561-723-0666