Provider Demographics
NPI:1154348126
Name:ADVANTACARE PAIN MANAGEMENT CENTERS INC
Entity type:Organization
Organization Name:ADVANTACARE PAIN MANAGEMENT CENTERS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COO
Authorized Official - Prefix:MR
Authorized Official - First Name:BARRY
Authorized Official - Middle Name:KENNETH
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-229-7387
Mailing Address - Street 1:509 W COLONIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32804-6803
Mailing Address - Country:US
Mailing Address - Phone:407-898-2522
Mailing Address - Fax:407-898-2102
Practice Address - Street 1:509 W COLONIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32804-6803
Practice Address - Country:US
Practice Address - Phone:407-898-2522
Practice Address - Fax:407-898-2102
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-16
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLCH6418111N00000X
FLCH7586111N00000X
FLOS5530207QS0010X
FLME823892081P2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered111N00000XChiropractic ProvidersChiropractorGroup - Single Specialty
Not Answered207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports MedicineGroup - Single Specialty
Not Answered2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty