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General NPI Number Information
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NPI Number | 1942603899
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Entity Type | Organization
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Legal Business Name | PAIN MEDICINE PHYSICIANS OF JACKSONVILLE, LLC
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Dates
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Enumeration Date | 10/07/2014
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Last Update Date | 01/27/2017
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Provider Practice Location Address
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Address Line | 10250 NORMANDY BOULEVARD SUITE 702
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City | JACKSONVILLE
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State | FL
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Zip | 32221
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Country | US
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Telephone | 904-495-7200
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Fax | 904-495-7199
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Provider Business Mailing Address
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Address Line | 10250 NORMANDY BLVD SUITE 703
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City | JACKSONVILLE
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State | FL
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Zip | 32221-8059
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Country | US
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Telephone | 904-495-7200
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Fax | 904-495-7199
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Authorized Official
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Title or Position | MEDICAL DIRECTOR
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Name | DR. PARVEEN KHANNA
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Credential | MD
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Telephone | 904-495-7200
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207L00000X
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Taxonomy Name | Anesthesiology Physician
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License Number | ME87424
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 207LP2900X
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Taxonomy Name | Pain Medicine (Anesthesiology) Physician
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License Number | ME87424
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License Number State | FL
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