Healthcare Provider Details

I. General information

NPI: 1255363792
Provider Name (Legal Business Name): INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2006
Last Update Date: 11/14/2023
Certification Date: 11/14/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1111 SE FEDERAL HWY # 228
STUART FL
34994-3840
US

IV. Provider business mailing address

PO BOX 744069
ATLANTA GA
30374-4069
US

V. Phone/Fax

Practice location:
  • Phone: 772-221-7966
  • Fax: 561-833-0813
Mailing address:
  • Phone:
  • 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: KAREN VAUGHN
Title or Position: OFFICER
Credential:
Phone: 404-450-4684