Healthcare Provider Details
I. General information
NPI: 1164455986
Provider Name (Legal Business Name): PREMIER PAIN CENTER
Entity Type: Organization
Gender:
Sole Proprietor:
II. Dates (important events)
Enumeration Date: 07/07/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:
III. Provider practice location address
5975 SUNSET DR SUITE 804
SOUTH MIAMI FL
33143-5166
US
IV. Provider business mailing address
5975 SUNSET DR SUITE 804
SOUTH MIAMI FL
33143-5166
US
V. Phone/Fax
- Phone: 305-740-2336
- Fax: 305-740-2344
- Phone: 305-740-2336
- Fax: 305-740-2344
VI. Provider taxonomy
Scope of Practice (Provider specialty)
| # 1 | |
| Primary Taxonomy | Y |
| Taxonomy Code | 261QA1903X |
| Taxonomy | Ambulatory Surgical Clinic/Center |
| License Number | |
| License Number State | |
VIII. Authorized Official
Name: DR.
EMILIO
SUAREZ
Title or Position: MEDICAL DIRECTOR
Credential: D.O.
Phone: 305-740-2336