Basic Information
| Provider Information | |||||||||
| NPI: | 1407962137 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | PAIN MEDICINE ASSOCIATES P.A. | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3945 CLARK RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419264770 | ||||||||
| FaxNumber: | 9419232520 | ||||||||
| Practice Location | |||||||||
| Address1: | 3945 CLARK RD | ||||||||
| Address2: | |||||||||
| City: | SARASOTA | ||||||||
| State: | FL | ||||||||
| PostalCode: | 342332364 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9419264770 | ||||||||
| FaxNumber: | 9419232520 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/23/2006 | ||||||||
| LastUpdateDate: | 03/27/2014 | ||||||||
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| AuthorizedOfficialLastName: | FASSY | ||||||||
| AuthorizedOfficialFirstName: | LYNN | ||||||||
| AuthorizedOfficialMiddleName: | R | ||||||||
| AuthorizedOfficialTitleorPosition: | OWNER | ||||||||
| AuthorizedOfficialTelephone: | 9419264770 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 208VP0000X | ME64532 | FL | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Pain Medicine | Pain Medicine |
No ID Information.