Provider Demographics
NPI:1093993396
Name:COMPREHENSIVE PAIN CARE OF SOUTH FLORIDA LLC
Entity type:Organization
Organization Name:COMPREHENSIVE PAIN CARE OF SOUTH FLORIDA LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KINYATA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:561-795-8655
Mailing Address - Street 1:2585 S STATE ROAD 7 STE 110
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-9438
Mailing Address - Country:US
Mailing Address - Phone:561-795-8655
Mailing Address - Fax:561-795-8449
Practice Address - Street 1:2585 S STATE ROAD 7 STE 110
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-9438
Practice Address - Country:US
Practice Address - Phone:561-795-8655
Practice Address - Fax:561-795-8449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-08
Last Update Date:2025-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME56226174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLI 04148Medicare UPIN
FL34326Medicare PIN
FLE20440Medicare UPIN
FLD84708Medicare UPIN
FLH28740Medicare UPIN
FLH49446Medicare UPIN