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BEACHES BEHAVIORAL MEDICINE NPI 1417309832


NPI Information

NPI: 1417309832
Provider Name: BEACHES BEHAVIORAL MEDICINE

Doing Business As: BEACHES LASER SPINE AND PAIN MEDICINE

Classification: Pain Medicine - 208VP0014X
Entity Type: Organization

Specialization: Interventional Pain Medicine

CLIA Number: 10D2123363

Address:
1351 13TH AVE S STE 120
JACKSONVILLE BEACH, FL
ZIP 32250
Phone: (904) 280-6701
Get Directions

BEACHES BEHAVIORAL MEDICINE is an interventional pain medicine pain medicine in Jacksonville Beach, FL. The provider is interventional Pain Medicine is the discipline of medicine devoted to the diagnosis and treatment of pain and related disorders principally with the application of interventional techniques in managing subacute, chronic, persistent, and intractable pain, independently or in conjunction with other modalities of treatment. BEACHES BEHAVIORAL MEDICINE NPI is 1417309832. The provider is registered as an organization entity type and is a multiple single specialty group.
The provider Is Doing Business As Beaches Laser Spine And Pain Medicine.

The provider's business location address is:

1351 13TH AVE S STE 120
JACKSONVILLE BEACH, FL
ZIP 32250-237
Phone: (904) 280-6701
Fax: (904) 280-6702

The provider's authorized official is Justin Kuhns Spooner .
The authorized official title is President and has the following contact phone number (904) 280-6701.

The CLIA number assigned to this NPI record is 10D2123363 - physician office with a certificate type of Certificate of Waiver.

The enumeration date for this NPI number is 7/9/2016 and was last updated on 1/12/2023.


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 CodeTaxonomy ClasificationTaxonomy SpecializationLicense NumberLicense StatePrimary
12084P0804XPsychiatry & NeurologyChild & Adolescent PsychiatryNo
22084P2900XPsychiatry & NeurologyPain MedicineNo
3207QA0401XFamily MedicineAddiction MedicineME115625FLORIDANo
42083A0300XPreventive MedicineAddiction MedicineNo
52084A0401XPsychiatry & NeurologyAddiction MedicineNo
62084P0800XPsychiatry & NeurologyPsychiatryNo
7208VP0000XPain MedicinePain MedicineNo
8208VP0014XPain MedicineInterventional Pain MedicineYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.Other Provider IdentifierOther Provider Identifier TypeOther Provider Identifier StateOther Provider Identifier Issuer
100863244100MEDICAIDFLORIDA

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: 4/28/2024

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