Provider Demographics
NPI:1104104785
Name:SAR PAIN INSTITUTE LLC
Entity type:Organization
Organization Name:SAR PAIN INSTITUTE LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:MEDICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:STEPHEN
Authorized Official - Middle Name:MARK
Authorized Official - Last Name:ROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD,PHD
Authorized Official - Phone:239-471-0721
Mailing Address - Street 1:2706 SE SANTA BARBARA PL
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33904-2701
Mailing Address - Country:US
Mailing Address - Phone:239-471-0721
Mailing Address - Fax:239-471-0732
Practice Address - Street 1:2706 SE SANTA BARBARA PL
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33904-2701
Practice Address - Country:US
Practice Address - Phone:239-471-0721
Practice Address - Fax:239-471-0732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-29
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMC 1621261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLFK751AOtherMEDICARE PTAN
FLPMC1621OtherPAIN CLINIC
FLBR4247791OtherDEA