Provider Demographics
NPI:1124058854
Name:INTERVENTIONAL PAIN INSTITUTE OF WEST FLORIDA, INC
Entity type:Organization
Organization Name:INTERVENTIONAL PAIN INSTITUTE OF WEST FLORIDA, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MD/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:HASHIM
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:727-861-1000
Mailing Address - Street 1:7412 COMMUNITY CT
Mailing Address - Street 2:
Mailing Address - City:HUDSON
Mailing Address - State:FL
Mailing Address - Zip Code:34667-7101
Mailing Address - Country:US
Mailing Address - Phone:727-861-1000
Mailing Address - Fax:727-681-1010
Practice Address - Street 1:7412 COMMUNITY CT
Practice Address - Street 2:
Practice Address - City:HUDSON
Practice Address - State:FL
Practice Address - Zip Code:34667-7101
Practice Address - Country:US
Practice Address - Phone:727-861-1000
Practice Address - Fax:727-681-1010
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-05
Last Update Date:2013-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME74355208VP0014X, 207L00000X
207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207L00000XAllopathic & Osteopathic PhysiciansAnesthesiologyGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL101164OtherAVMED VENDOR ID
FL051608200Medicaid
FL051608200Medicaid