Healthcare Provider Details

I. General information

NPI: 1891018933
Provider Name (Legal Business Name): PAIN FACILITY MANAGEMENT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2010
Last Update Date: 06/17/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1849 BARATARIA BLVD
MARRERO LA
70072-4203
US

IV. Provider business mailing address

3348 W ESPLANADE AVE S SUITE A
METAIRIE LA
70002-3475
US

V. Phone/Fax

Practice location:
  • Phone: 504-207-7555
  • Fax: 504-207-7556
Mailing address:
  • Phone: 504-887-7207
  • Fax: 504-889-1868

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207P00000X
TaxonomyEmergency Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State

VIII. Authorized Official

Name: MR. RENE JOSEPH MIRE
Title or Position: CFO
Credential:
Phone: 504-887-7207