MEDICARE: CONSULTANTS IN PAIN MEDICINE, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208VP0014X	Interventional Pain Medicine Physician

General Provider Information

NPI Number	:	1104775600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CONSULTANTS IN PAIN MEDICINE, LLC

Provider Business Mailing Address
First Line	:	5191 FIRST COAST TECH PKWY FL 3
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-0609
Country	:	US
Telephone Number	:	904-223-3321
Fax Number	:	904-223-2169

Provider Business Practice Location Address
First Line	:	2658 US HIGHWAY 17 SOUTH
Second Line	:
City	:	RICHMOND HILL
State	:	GA
Zip	:	31324-3374
Country	:	US
Telephone Number	:	912-590-0973
Fax Number	:	912-590-0180

Authorized Official
Title or Position	:	CREDENTIALING MANAGER
Name	:	ALICIA M GROTH
Credential	:
Telephone Number	:	904-223-3321

Provider Enumeration Date	:	01/27/2026
Last Update Date	:	02/03/2026

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