Provider Demographics
NPI:1144913666
Name:FLORIDA INSTITUTE OF PAIN MEDICINE LLC
Entity type:Organization
Organization Name:FLORIDA INSTITUTE OF PAIN MEDICINE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:R
Authorized Official - Last Name:FOLTZ
Authorized Official - Suffix:II
Authorized Official - Credentials:MD
Authorized Official - Phone:904-449-7246
Mailing Address - Street 1:PO BOX 734905
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-4905
Mailing Address - Country:US
Mailing Address - Phone:904-449-7246
Mailing Address - Fax:904-719-7571
Practice Address - Street 1:57 TOWN CT STE 121
Practice Address - Street 2:
Practice Address - City:PALM COAST
Practice Address - State:FL
Practice Address - Zip Code:32164-2425
Practice Address - Country:US
Practice Address - Phone:904-593-9503
Practice Address - Fax:904-719-7573
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-31
Last Update Date:2023-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Multi-Specialty