Provider Demographics
NPI:1396404836
Name:MMCO PAIN MANAGEMENT LLC
Entity type:Organization
Organization Name:MMCO PAIN MANAGEMENT LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:MERCEDES
Authorized Official - Last Name:CRISTANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:954-934-9856
Mailing Address - Street 1:1800 N FEDERAL HWY STE 105
Mailing Address - Street 2:
Mailing Address - City:POMPANO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33062-1011
Mailing Address - Country:US
Mailing Address - Phone:954-934-9856
Mailing Address - Fax:954-934-9464
Practice Address - Street 1:1800 N FEDERAL HWY STE 105
Practice Address - Street 2:
Practice Address - City:POMPANO BEACH
Practice Address - State:FL
Practice Address - Zip Code:33062-1011
Practice Address - Country:US
Practice Address - Phone:954-934-9856
Practice Address - Fax:954-934-9464
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-13
Last Update Date:2023-09-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
No207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
No208VP0000XAllopathic & Osteopathic PhysiciansPain MedicinePain MedicineGroup - Single Specialty
No261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPainGroup - Single Specialty