Provider Demographics
NPI:1285182659
Name:FLORIDA PAIN SPECIALISTS PLLC
Entity type:Organization
Organization Name:FLORIDA PAIN SPECIALISTS PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:VP OF OPERATIONS
Authorized Official - Prefix:
Authorized Official - First Name:SHANNON
Authorized Official - Middle Name:
Authorized Official - Last Name:RILEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-647-5266
Mailing Address - Street 1:4100 SOUTHPOINT DR E STE 1
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-8710
Mailing Address - Country:US
Mailing Address - Phone:046-475-2669
Mailing Address - Fax:904-770-5594
Practice Address - Street 1:4100 SOUTHPOINT DR E STE 1
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-8710
Practice Address - Country:US
Practice Address - Phone:046-475-2669
Practice Address - Fax:904-770-5594
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-09-14
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
2081P2900X, 2081S0010X, 208VP0014X, 261QP3300X
FLPA9105187314000000X
FLME117856314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No2081P2900XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationPain MedicineGroup - Single Specialty
No2081S0010XAllopathic & Osteopathic PhysiciansPhysical Medicine & RehabilitationSports MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1487954723OtherNPI
FL1578898524OtherNPI