MEDICARE: INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC

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	208VP0000X	Pain Medicine Physician
2	207LP2900X	Pain Medicine (Anesthesiology) Physician

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1245905454
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC

Provider Business Mailing Address
First Line	:	PO BOX 744069
Second Line	:
City	:	ATLANTA
State	:	GA
Zip	:	30374-4069
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4510 DONALD ROSS RD # 203
Second Line	:
City	:	PALM BEACH GARDENS
State	:	FL
Zip	:	33418-6783
Country	:	US
Telephone Number	:	877-328-1119
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KAREN VAUGHN
Credential	:
Telephone Number	:	404-450-4684

Provider Enumeration Date	:	08/10/2021
Last Update Date	:	11/14/2023

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