=====================================================
General NPI Number Information
=====================================================
NPI Number | 1558464941
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMERICAN PAIN MANAGEMENT CENTER INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/07/2006
-----------------------------------------------------
Last Update Date | 12/13/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7710 NW 71ST CT SUITE 202
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-726-4448
-----------------------------------------------------
Fax | 954-726-5472
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7710 NW 71ST CT SUITE 202
-----------------------------------------------------
City | TAMARAC
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33321-2973
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 954-726-4448
-----------------------------------------------------
Fax | 954-726-5472
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. SCOTT NOVICK
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 954-726-4448
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 332900000X
-----------------------------------------------------
Taxonomy Name | Non-Pharmacy Dispensing Site
-----------------------------------------------------
License Number | HCC5312
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 174400000X
-----------------------------------------------------
Taxonomy Name | Specialist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------