# PREMIER PAIN INC

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1053183111
- **Authorized official:** NINEDTY CORDOVA APRN (OWNER)
- **Authorized official phone:** (754) 888-9080

## Contact information

- **Practice address:** 9050 PINES BLVD STE 301, PEMBROKE PINES, FL 33024-6422
- **Practice address phone:** (754) 888-9080
- **Practice address fax:** (754) 888-9280
- **Mailing address:** 9050 PINES BLVD STE 301, PEMBROKE PINES, FL 33024-6422
- **Mailing address phone:** (754) 888-9080
- **Mailing address fax:** (754) 888-9280

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QP2000X | Physical Therapy Clinic/Center | — | NULL | — |
| 261QP3300X | Pain Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 10/23/2023
- **Last updated:** 10/24/2023