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SOUTH LAKE PAIN INSTITUTE INC NPI 1033121546


NPI Information

NPI: 1033121546
Provider Name: SOUTH LAKE PAIN INSTITUTE, INC

Former Legal Business Name: SOUTH LAKE PAIN INSTITUTE, PA

Classification: Specialist - 174400000X
Entity Type: Organization

CLIA Number: 10D1075893

Address:
2440 HOOKS STREET
CLERMONT, FL
ZIP 34711
Phone: (352) 394-0833
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SOUTH LAKE PAIN INSTITUTE, INC is a specialist in Clermont, FL. The provider is an individual educated and trained in an applied knowledge discipline used in the performance of work at a level requiring knowledge and skills beyond or apart from that provided by a general education or liberal arts degree. SOUTH LAKE PAIN INSTITUTE, INC NPI is 1033121546. The provider is registered as an organization entity type and is a multi-specialty group.
The provider Former Legal Business Name Is South Lake Pain Institute, Pa.

The provider's business location address is:

2440 HOOKS STREET
CLERMONT, FL
ZIP 34711
Phone: (352) 394-0833
Fax: (352) 394-0367

The provider's authorized official is Samildre Pacheco .
The authorized official title is Practice Administrator and has the following contact phone number (352) 394-0833.

The CLIA number assigned to this NPI record is 10D1075893 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 8/13/2006 and was last updated on 10/8/2019.


Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1174400000XSpecialistOS8836FLORIDANo
2174400000XSpecialistFLORIDAYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

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