Healthcare Provider Details

I. General information

NPI: 1760906929
Provider Name (Legal Business Name): INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/31/2017
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 NE 19TH DR STE 208
OKEECHOBEE FL
34972-1932
US

IV. Provider business mailing address

PO BOX 744069
ATLANTA GA
30374-4069
US

V. Phone/Fax

Practice location:
  • Phone: 772-223-2115
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

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