Healthcare Provider Details

I. General information

NPI: 1720302946
Provider Name (Legal Business Name): FIRST COAST PAIN AND SPINE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/17/2010
Last Update Date: 06/17/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 WHETSTONE PL STE 310
ST AUGUSTINE FL
32086-5775
US

IV. Provider business mailing address

PO BOX 830941
BIRMINGHAM AL
35283-0941
US

V. Phone/Fax

Practice location:
  • Phone: 904-819-4478
  • Fax:
Mailing address:
  • Phone: 866-480-2246
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MICHAEL ADKISON
Title or Position: PRESIDENT
Credential: MD
Phone: 904-819-4478