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	207LP2900X	Pain Medicine (Anesthesiology) Physician

General Provider Information

NPI Number	:	1932771276
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INTERVENTIONAL REHABILITATION OF SOUTH FLORIDA, INC

Provider Business Mailing Address
First Line	:	5565 CENTERVIEW DR STE 107
Second Line	:
City	:	RALEIGH
State	:	NC
Zip	:	27606-3563
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	3995 NW GOLDENROD RD
Second Line	:
City	:	JENSEN BEACH
State	:	FL
Zip	:	34957-3699
Country	:	US
Telephone Number	:	877-328-1119
Fax Number	:

Authorized Official
Title or Position	:	OFFICER
Name	:	KATHY KONDAS
Credential	:
Telephone Number	:	877-328-1119

Provider Enumeration Date	:	07/15/2021
Last Update Date	:	07/15/2021

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