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
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