Provider Demographics
NPI:1538423157
Name:PALM BEACH PAIN INSTITUTE INC
Entity type:Organization
Organization Name:PALM BEACH PAIN INSTITUTE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARCIE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MERSON
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:561-499-7020
Mailing Address - Street 1:5130 LINTON BLVD
Mailing Address - Street 2:SUITE C-2
Mailing Address - City:DELRAY BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33484-6596
Mailing Address - Country:US
Mailing Address - Phone:561-499-7020
Mailing Address - Fax:561-499-7942
Practice Address - Street 1:5130 LINTON BLVD
Practice Address - Street 2:SUITE C-2
Practice Address - City:DELRAY BEACH
Practice Address - State:FL
Practice Address - Zip Code:33484-6596
Practice Address - Country:US
Practice Address - Phone:561-499-7020
Practice Address - Fax:561-499-7942
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-06-28
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLGF307AMedicare PIN