Healthcare Provider Details

I. General information

NPI: 1891713673
Provider Name (Legal Business Name): ASSC PAIN MANAGMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/18/2006
Last Update Date: 02/12/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6280 SUNSET DR
SOUTH MIAMI FL
33143-4827
US

IV. Provider business mailing address

PO BOX 431851
MIAMI FL
33243-1851
US

V. Phone/Fax

Practice location:
  • Phone: 305-251-3991
  • Fax: 305-251-7982
Mailing address:
  • Phone: 305-251-3991
  • Fax: 305-251-7982

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberXXXXX
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License NumberXXXXX
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME0038817
License Number StateFL

VIII. Authorized Official

Name: DR. FRANK VILASUSO
Title or Position: MD
Credential:
Phone: 305-251-3991