Organization
INTERVENTIONAL PAIN SERVICE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. WILLIAM ROSS MAYFIELD M.D. (MEMBER MANAGER)
(386) 254-4029
Entity
Organization
Contact information
Practice address
201 N CLYDE MORRIS BLVD, SUITE 120, DAYTONA BEACH, FL 32114-2724
(386) 254-4029
(386) 254-4274
Mailing address
201 N CLYDE MORRIS BLVD, SUITE 120, DAYTONA BEACH, FL 32114-2724
(386) 254-4029
(386) 254-4274
Taxonomy
Speciality
Code
Description
License number
State
208VP0014X
Interventional Pain Medicine Physician
Primary
ME0063660
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
18828
BLUE SHIELD
FL
05
—
372693200
—
FL
Enumeration date
08/02/2006
Last updated
08/22/2020
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