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General NPI Number Information
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NPI Number | 1649284928
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Entity Type | Organization
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Legal Business Name | PAIN MANAGEMENT CONSULTANTS OF SOUTHWEST FLORIDA, PL
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Dates
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Enumeration Date | 07/29/2006
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Last Update Date | 04/25/2019
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Provider Practice Location Address
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Address Line | 7964 SUMMERLIN LAKES DR
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City | FORT MYERS
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State | FL
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Zip | 33907-1816
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Country | US
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Telephone | 239-333-1177
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Fax | 239-333-1169
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Provider Business Mailing Address
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Address Line | PO BOX 7440
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City | FORT MYERS
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State | FL
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Zip | 33911-7440
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Country | US
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Telephone | 239-333-1177
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Fax | 239-939-4733
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Authorized Official
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Title or Position | MANAGER
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Name | DR. EUGENE D MAHANEY
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Credential | MD
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Telephone | 239-333-1177
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number |
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License Number State |
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