MEDICARE: PREMIER PAIN SPECIALISTS 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	207LP2900X	Pain Medicine (Anesthesiology) Physician	ME72077	FL

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
4	050085760	OTHER	FL	MEDICARE RAILROAD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	1132487	OTHER	FL	FIRST HEALTH
2	0403035	OTHER	FL	WORKERS COMPENSATON
3	352107800	OTHER	FL	ACS
5	43550	OTHER	FL	BLUE CROSS BLUE SHIELD OF
6	285839	OTHER	FL	BC/BS VIRTUAL
7	7040371	OTHER	FL	AETNA
8	P2816206	OTHER	FL	OXFORD

General Provider Information

NPI Number	:	1962589671
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PREMIER PAIN SPECIALISTS LLC

Provider Business Mailing Address
First Line	:	1228 SE 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3210
Country	:	US
Telephone Number	:	239-945-1105
Fax Number	:	239-945-4495

Provider Business Practice Location Address
First Line	:	1228 SE 8TH TER
Second Line	:
City	:	CAPE CORAL
State	:	FL
Zip	:	33990-3210
Country	:	US
Telephone Number	:	239-945-1105
Fax Number	:	239-945-4495

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. JULES ALVA PREUDHOMME
Credential	:	M.D
Telephone Number	:	239-945-1105

Provider Enumeration Date	:	11/01/2006
Last Update Date	:	12/02/2021

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Directions to “PREMIER PAIN SPECIALISTS LLC ” Practice Location

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