Provider Demographics
NPI:1437248150
Name:ADVANCED PAIN MANAGEMENT SPECIALISTS
Entity type:Organization
Organization Name:ADVANCED PAIN MANAGEMENT SPECIALISTS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PARTNER
Authorized Official - Prefix:
Authorized Official - First Name:JONATHAN
Authorized Official - Middle Name:S
Authorized Official - Last Name:DAITCH
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:239-437-8002
Mailing Address - Street 1:PO BOX 07400
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33919-0400
Mailing Address - Country:US
Mailing Address - Phone:239-437-8000
Mailing Address - Fax:239-437-9991
Practice Address - Street 1:1425 VISCAYA PKWY
Practice Address - Street 2:SUITE 202
Practice Address - City:CAPE CORAL
Practice Address - State:FL
Practice Address - Zip Code:33990-3294
Practice Address - Country:US
Practice Address - Phone:239-574-1464
Practice Address - Fax:239-574-1286
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-12
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207LP2900XAllopathic & Osteopathic PhysiciansAnesthesiologyPain MedicineGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL7926233OtherAETNA GROUP NUMBER
FL74588OtherBCBS/FL GROUP NUMBER
FLCH8338OtherRAILROAD MEDICARE GROUP #
FL7926233OtherAETNA GROUP NUMBER