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General NPI Number Information
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NPI Number | 1104104785
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Entity Type | Organization
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Legal Business Name | SAR PAIN INSTITUTE LLC
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Dates
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Enumeration Date | 07/29/2011
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 2706 SE SANTA BARBARA PL
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City | CAPE CORAL
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State | FL
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Zip | 33904-2701
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Country | US
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Telephone | 239-471-0721
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Fax | 239-471-0732
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Provider Business Mailing Address
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Address Line | 2706 SE SANTA BARBARA PL
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City | CAPE CORAL
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State | FL
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Zip | 33904-2701
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Country | US
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Telephone | 239-471-0721
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Fax | 239-471-0732
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | STEPHEN MARK ROSS
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Credential | M.D.,PHD.
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Telephone | 239-471-0721
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP3300X
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Taxonomy Name | Pain Clinic/Center
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License Number | PMC 1621
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License Number State | FL
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