Provider Demographics
NPI:1700976578
Name:BROOKSVILLE PAIN MANAGEMENT, INC.
Entity type:Organization
Organization Name:BROOKSVILLE PAIN MANAGEMENT, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:DOYLE
Authorized Official - Last Name:COURTNEY
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:352-597-7111
Mailing Address - Street 1:5467 COMMERCIAL WAY
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:FL
Mailing Address - Zip Code:34606-1110
Mailing Address - Country:US
Mailing Address - Phone:352-597-7111
Mailing Address - Fax:352-597-7171
Practice Address - Street 1:5467 COMMERCIAL WAY
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:FL
Practice Address - Zip Code:34606-1110
Practice Address - Country:US
Practice Address - Phone:352-597-7111
Practice Address - Fax:352-597-7171
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-13
Last Update Date:2010-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLME0067353261QP3300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP3300XAmbulatory Health Care FacilitiesClinic/CenterPain
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLME0067353OtherMEDICAL LICENSE
FLME0067353OtherMEDICAL LICENSE
26400Medicare PIN