Provider Demographics
NPI:1215111596
Name:BCMD PAIN MANAGEMENT PLLC
Entity type:Organization
Organization Name:BCMD PAIN MANAGEMENT PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:BLAINE
Authorized Official - Middle Name:SIMON
Authorized Official - Last Name:CAMERON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:877-412-7272
Mailing Address - Street 1:6586 HYPOLUXO RD
Mailing Address - Street 2:SUITE #334
Mailing Address - City:LAKE WORTH
Mailing Address - State:FL
Mailing Address - Zip Code:33467-7678
Mailing Address - Country:US
Mailing Address - Phone:877-412-7272
Mailing Address - Fax:561-967-0954
Practice Address - Street 1:6056 BOYNTON BEACH BLVD STE 115
Practice Address - Street 2:
Practice Address - City:BOYNTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:33437-3500
Practice Address - Country:US
Practice Address - Phone:877-412-7272
Practice Address - Fax:561-967-0954
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-23
Last Update Date:2021-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME86864261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain