Provider Demographics
NPI:1962589671
Name:PREMIER PAIN SPECIALISTS LLC
Entity type:Organization
Organization Name:PREMIER PAIN SPECIALISTS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JULES
Authorized Official - Middle Name:ALVA
Authorized Official - Last Name:PREUDHOMME
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-945-1105
Mailing Address - Street 1:1228 SE 8TH TER
Mailing Address - Street 2:
Mailing Address - City:CAPE CORAL
Mailing Address - State:FL
Mailing Address - Zip Code:33990-3210
Mailing Address - Country:US
Mailing Address - Phone:239-945-1105
Mailing Address - Fax:239-945-4495
Practice Address - Street 1:1228 SE 8TH TER
Practice Address - Street 2:
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3210
Practice Address - Country:US
Practice Address - Phone:239-945-1105
Practice Address - Fax:239-945-4495
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-01
Last Update Date:2021-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME72077207LP2900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1132487OtherFIRST HEALTH
FL0403035OtherWORKERS COMPENSATON
FL352107800OtherACS
FL050085760OtherMEDICARE RAILROAD
FL43550OtherBLUE CROSS BLUE SHIELD OF
FL285839OtherBC/BS VIRTUAL
FL7040371OtherAETNA
FLP2816206OtherOXFORD
FL7040371OtherAETNA
FL352107800OtherUS DEPT OF LABOR
FL0403035OtherWORKERS COMPENSATON
FL7040371OtherAETNA
FLK3296Medicare ID - Type Unspecified
FL5607240001Medicare NSC
FL=========OtherUNITED HEALTH CARE
FL352107800OtherUS DEPT OF LABOR