Healthcare Provider Details

I. General information

NPI: 1558464941
Provider Name (Legal Business Name): AMERICAN PAIN MANAGEMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2006
Last Update Date: 12/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7710 NW 71ST CT SUITE 202
TAMARAC FL
33321-2973
US

IV. Provider business mailing address

7710 NW 71ST CT SUITE 202
TAMARAC FL
33321-2973
US

V. Phone/Fax

Practice location:
  • Phone: 954-726-4448
  • Fax: 954-726-5472
Mailing address:
  • Phone: 954-726-4448
  • Fax: 954-726-5472

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License NumberHCC5312
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number State

VIII. Authorized Official

Name: MR. SCOTT NOVICK
Title or Position: ADMINISTRATOR
Credential:
Phone: 954-726-4448