Provider Demographics
NPI:1427156140
Name:PAIN CLINIC OF NORTHWEST FL INC
Entity type:Organization
Organization Name:PAIN CLINIC OF NORTHWEST FL INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:JAY
Authorized Official - Last Name:JOSEPH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:850-784-2477
Mailing Address - Street 1:2250 HARRISON AVE
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32405-4548
Mailing Address - Country:US
Mailing Address - Phone:850-784-2477
Mailing Address - Fax:850-784-6848
Practice Address - Street 1:2250 HARRISON AVE
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32405-4548
Practice Address - Country:US
Practice Address - Phone:850-784-2477
Practice Address - Fax:850-784-6848
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-20
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPMC 150174400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLCM7126OtherRRB PTAN
FLK2846Medicare UPIN
FL3857260001Medicare NSC