Provider Demographics
NPI:1558133694
Name:POWER SPINE & PAIN
Entity type:Organization
Organization Name:POWER SPINE & PAIN
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:
Authorized Official - Last Name:DEVEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:904-342-0438
Mailing Address - Street 1:308 KINGSLEY LAKE DR STE 802
Mailing Address - Street 2:
Mailing Address - City:SAINT AUGUSTINE
Mailing Address - State:FL
Mailing Address - Zip Code:32092-3046
Mailing Address - Country:US
Mailing Address - Phone:904-342-0438
Mailing Address - Fax:904-342-0498
Practice Address - Street 1:308 KINGSLEY LAKE DR STE 802
Practice Address - Street 2:
Practice Address - City:SAINT AUGUSTINE
Practice Address - State:FL
Practice Address - Zip Code:32092-3046
Practice Address - Country:US
Practice Address - Phone:904-342-0438
Practice Address - Fax:904-342-0498
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-10-23
Last Update Date:2024-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty