Healthcare Provider Details

I. General information

NPI: 1407962137
Provider Name (Legal Business Name): PAIN MEDICINE ASSOCIATES P.A.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/23/2006
Last Update Date: 03/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3945 CLARK RD
SARASOTA FL
34233-2364
US

IV. Provider business mailing address

3945 CLARK RD
SARASOTA FL
34233-2364
US

V. Phone/Fax

Practice location:
  • Phone: 941-926-4770
  • Fax: 941-923-2520
Mailing address:
  • Phone: 941-926-4770
  • Fax: 941-923-2520

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME64532
License Number StateFL

VIII. Authorized Official

Name: LYNN R FASSY
Title or Position: OWNER
Credential: M.D.
Phone: 941-926-4770