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NPI Code Detail

MEDICARE: PAIN RELIEF AND REHAB PHYSICIANS GROUP INC

MEDICARE: PAIN RELIEF AND REHAB PHYSICIANS GROUP 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
1261QM1300XMulti-Specialty Clinic/Center

General Provider Information

NPI Number : 1972161776
Entity Type Code : Organization
Provider Name (Legal Business Name) : PAIN RELIEF AND REHAB PHYSICIANS GROUP INC
Provider Business Mailing Address
First Line : 6444 BEACH BLVD STE 200
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2891
Country : US
Telephone Number : 571-436-9232
Fax Number :
Provider Business Practice Location Address
First Line : 6444 BEACH BLVD STE 2002
Second Line :
City : JACKSONVILLE
State : FL
Zip : 32216-2891
Country : US
Telephone Number : 571-436-9232
Fax Number :
Authorized Official
Title or Position : OWNER
Name : JOSEPH M GHANEM
Credential :
Telephone Number : 571-436-9232
Provider Enumeration Date : 06/05/2019
Last Update Date : 06/05/2019

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Directions to “PAIN RELIEF AND REHAB PHYSICIANS GROUP INC ” Practice Location

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