Provider Demographics
NPI:1972161776
Name:PAIN RELIEF AND REHAB PHYSICIANS GROUP INC
Entity type:Organization
Organization Name:PAIN RELIEF AND REHAB PHYSICIANS GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:M
Authorized Official - Last Name:GHANEM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:571-436-9232
Mailing Address - Street 1:6444 BEACH BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32216-2891
Mailing Address - Country:US
Mailing Address - Phone:571-436-9232
Mailing Address - Fax:
Practice Address - Street 1:6444 BEACH BLVD STE 2002
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32216-2891
Practice Address - Country:US
Practice Address - Phone:571-436-9232
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-06-05
Last Update Date:2019-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty