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General NPI Number Information
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NPI Number | 1447527791
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Entity Type | Organization
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Legal Business Name | BODY PAIN MEDICAL CENTER, INC.
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Dates
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Enumeration Date | 11/30/2011
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Last Update Date | 11/30/2011
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Provider Practice Location Address
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Address Line | 11680 BONITA BEACH RD SE SUITE 100
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-5993
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Country | US
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Telephone | 386-334-6355
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Fax |
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Provider Business Mailing Address
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Address Line | 11680 BONITA BEACH RD SE SUITE 100
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City | BONITA SPRINGS
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State | FL
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Zip | 34135-5993
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Country | US
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Telephone | 386-334-6355
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Fax |
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Authorized Official
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Title or Position | OWNER/DIRECTOR
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Name | DR. ROBERT M BODINE
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Credential | CH
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Telephone | 386-334-6355
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | CH9685
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License Number State | FL
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