MEDICARE: AXIOM PAIN MANAGEMENT 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	:	1184945917
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AXIOM PAIN MANAGEMENT LLC

Provider Business Mailing Address
First Line	:	6947 MERRILL RD
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32277-2684
Country	:	US
Telephone Number	:	904-743-2222
Fax Number	:	904-743-3087

Provider Business Practice Location Address
First Line	:	2160 DUNN AVE
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32218-4718
Country	:	US
Telephone Number	:	904-743-2222
Fax Number	:	904-743-3087

Authorized Official
Title or Position	:	MANAGING PARTNER
Name	:	VIPUL PATEL
Credential	:	DC
Telephone Number	:	904-743-2222

Provider Enumeration Date	:	06/16/2010
Last Update Date	:	06/16/2010

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