Healthcare Provider Details

I. General information

NPI: 1932555745
Provider Name (Legal Business Name): ANESCO INTERVENTIONAL PAIN INSTITUTE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/11/2016
Last Update Date: 06/30/2021
Certification Date: 06/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2825 N STATE ROAD 7 STE 204
MARGATE FL
33063-5737
US

IV. Provider business mailing address

PO BOX 160805
ALTAMONTE SPRINGS FL
32716-0805
US

V. Phone/Fax

Practice location:
  • Phone: 954-580-4080
  • Fax:
Mailing address:
  • Phone: 954-580-4084
  • Fax: 954-580-4081

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT KOLBERT
Title or Position: VICE PRESIDENT
Credential: M.D.
Phone: 954-703-2933