MEDICARE: OKALOOSA PAIN CONSULTANTS P A

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	:	1851411474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKALOOSA PAIN CONSULTANTS P A

Provider Business Mailing Address
First Line	:	150 E REDSTONE AVE
Second Line	:	SUITE A
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-5357
Country	:	US
Telephone Number	:	850-689-8004
Fax Number	:	850-689-8086

Provider Business Practice Location Address
First Line	:	150 E REDSTONE AVE
Second Line	:	SUITE A
City	:	CRESTVIEW
State	:	FL
Zip	:	32539-5357
Country	:	US
Telephone Number	:	850-689-8004
Fax Number	:	850-689-8086

Authorized Official
Title or Position	:	DIRECTOR OF OPERATIONS
Name	:	JANA KAY WOOD
Credential	:
Telephone Number	:	850-689-8004

Provider Enumeration Date	:	03/29/2007
Last Update Date	:	04/07/2009

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Directions to “OKALOOSA PAIN CONSULTANTS P A ” Practice Location

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