Organization
PORT ST LUCIE PAIN MANAGEMENT PLLC
Active
Organization
PORT ST LUCIE PAIN MANAGEMENT PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DARLENE VANCE (PRACTICE ADMINISTRATOR)
(772) 335-7246
Entity
Organization
Contact information
Practice address
8235 SOUTH US HWY 1, PORT ST. LUCIE, FL 34952
(772) 335-7246
(772) 335-7202
Mailing address
8235 S US HIGHWAY 1, PORT ST LUCIE, FL 34952-2848
(772) 335-7246
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
—
—
207LP2900X
Pain Medicine (Anesthesiology) Physician
—
—
208VP0000X
Pain Medicine Physician
—
—
208VP0014X
Interventional Pain Medicine Physician
Primary
—
—
261QP3300X
Pain Clinic/Center
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
10719333
CAQH
—
01
—
15198A
MEDICARE ID
FL
01
—
E32589
UPIN
FL
Enumeration date
05/22/2007
Last updated
10/28/2020
Update your record
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