Healthcare Provider Details

I. General information

NPI: 1770975609
Provider Name (Legal Business Name): CENTER FOR INTERVENTIONAL PAIN MANAGEMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/02/2015
Last Update Date: 03/02/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1501 LAUREL ST SUITE 102
SARASOTA FL
34236-7039
US

IV. Provider business mailing address

1501 LAUREL ST SUITE 102
SARASOTA FL
34236-7039
US

V. Phone/Fax

Practice location:
  • Phone: 941-552-3488
  • Fax: 941-552-3486
Mailing address:
  • Phone: 941-552-3488
  • Fax: 941-552-3486

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME87545
License Number StateFL

VIII. Authorized Official

Name: ALLEN BAIDEY
Title or Position: PRESIDENT
Credential: MD
Phone: 941-552-3488