Healthcare Provider Details

I. General information

NPI: 1326429739
Provider Name (Legal Business Name): PIONEER PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2015
Last Update Date: 11/03/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8491 S FEDERAL HWY SUITE 15
PORT ST LUCIE FL
34952-3360
US

IV. Provider business mailing address

266 NW PEACOCK BLVD STE 205
PORT ST LUCIE FL
34986-2271
US

V. Phone/Fax

Practice location:
  • Phone: 772-324-8214
  • Fax: 772-324-8136
Mailing address:
  • Phone: 772-446-4883
  • Fax: 772-446-4875

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: ANTONIO POTO
Title or Position: OWNER
Credential:
Phone: 772-446-4883