Healthcare Provider Details

I. General information

NPI: 1750587911
Provider Name (Legal Business Name): PAIN RELIEF MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5040 NW 7ST SUITE 410
MIAMI FL
33126-3431
US

IV. Provider business mailing address

5040 NW 7ST SUITE 410
MIAMI FL
33126-3431
US

V. Phone/Fax

Practice location:
  • Phone: 305-569-0263
  • Fax: 305-569-0283
Mailing address:
  • Phone: 305-569-0263
  • Fax: 305-569-0283

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License NumberMM19829
License Number StateFL

VIII. Authorized Official

Name: MR. TOM LEONARD
Title or Position: PRESIDENT
Credential: MT
Phone: 305-569-0263