MEDICARE: NORTH BEACH PAIN & HEALTH CENTER, 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	261QH0100X	Health Service Clinic/Center	HCC8069	FL

General Provider Information

NPI Number	:	1871732602
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NORTH BEACH PAIN & HEALTH CENTER, INC.

Provider Business Mailing Address
First Line	:	16400 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4115
Country	:	US
Telephone Number	:	786-245-7444
Fax Number	:

Provider Business Practice Location Address
First Line	:	16400 NE 19TH AVE
Second Line	:
City	:	NORTH MIAMI BEACH
State	:	FL
Zip	:	33162-4115
Country	:	US
Telephone Number	:	786-245-7444
Fax Number	:

Authorized Official
Title or Position	:	GM
Name	:	MRS. VIKTORIYA PATRUSHEVA
Credential	:
Telephone Number	:	786-245-7444

Provider Enumeration Date	:	02/18/2009
Last Update Date	:	02/18/2009

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