Organization

Interventional Pain Service Llc

Interventional Pain Medicine Physician in Daytona Beach, FL(View on Map)

Legal Business Name

Interventional Pain Service Llc

NPI Number

1689681793

NPI Type

Organization

Enumeration Date

08/02/2006

Specialties

(Taxonomies)

Code

208VP0014X

Primary Taxonomy

Yes

Licenses

State

Florida

License Number

ME0063660

Contact
Information

Purpose

Mailing
Location

Address

201 N CLYDE MORRIS BLVD
201 N CLYDE MORRIS BLVD

City

Daytona Beach
Daytona Beach

State

FL
FL

Postal Code

32114-2724
32114-2724

Country

US
US

Telephone Number

(386) 254-4029
(386) 254-4029

Authorized Official

Name

Dr. William Mayfield

Title or Position

MEMBER MANAGER

Telephone Number

(386) 254-4029

Identifiers

Identifier

372693200
18828

Identifier State

FL
FL

Identifier Issuer

Unknown
BLUE SHIELD

Provider data last refreshed from NPPES NPI registry on 11/19/2024

Data last updated by provider on 08/22/2020

Provider Address

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