Healthcare Provider Details

I. General information

NPI: 1598276784
Provider Name (Legal Business Name): PREMIER PAIN MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2017
Last Update Date: 02/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3399 NW 72ND AVE STE 101
MIAMI FL
33122-1355
US

IV. Provider business mailing address

3399 NW 72ND AVE STE 101
MIAMI FL
33122-1355
US

V. Phone/Fax

Practice location:
  • Phone: 305-599-9933
  • Fax:
Mailing address:
  • Phone: 305-599-9933
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License Number
License Number State

VIII. Authorized Official

Name: HOSSEIN JOUKAR
Title or Position: PRESIDENT
Credential: MD
Phone: 305-599-9933