Provider Demographics
NPI:1962103697
Name:CONSULTANTS IN PAIN MEDICINE, LLC
Entity type:Organization
Organization Name:CONSULTANTS IN PAIN MEDICINE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALING
Authorized Official - Prefix:
Authorized Official - First Name:ALICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GROTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-256-2754
Mailing Address - Street 1:5191 FIRST COAST TECH PKWY FL 3
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32224-0609
Mailing Address - Country:US
Mailing Address - Phone:904-223-3321
Mailing Address - Fax:904-223-2169
Practice Address - Street 1:195 E TOLLISON ST BLDG C
Practice Address - Street 2:
Practice Address - City:BAXLEY
Practice Address - State:GA
Practice Address - Zip Code:31513-0172
Practice Address - Country:US
Practice Address - Phone:912-590-0973
Practice Address - Fax:912-590-0180
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CONSULTANTS IN PAIN MEDICINE, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2023-03-10
Last Update Date:2023-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Multi-Specialty