Healthcare Provider Details

I. General information

NPI: 1104591189
Provider Name (Legal Business Name): INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/12/2021
Last Update Date: 03/29/2023
Certification Date: 03/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 SW 172ND AVE
MIRAMAR FL
33029-5592
US

IV. Provider business mailing address

5565 CENTERVIEW DR STE 107
RALEIGH NC
27606-3563
US

V. Phone/Fax

Practice location:
  • Phone: 877-328-1119
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: KAREN VAUGHN
Title or Position: AUTHORIZED OFFICIAL
Credential:
Phone: 404-450-4684