Provider Demographics
NPI:1053621789
Name:AMERICAN PAIN ASSOCIATES LLC
Entity type:Organization
Organization Name:AMERICAN PAIN ASSOCIATES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MBR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGE
Authorized Official - Middle Name:S
Authorized Official - Last Name:PETRYK
Authorized Official - Suffix:
Authorized Official - Credentials:DC
Authorized Official - Phone:239-482-8239
Mailing Address - Street 1:15880 SUMMERLIN RD STE 300
Mailing Address - Street 2:PMB 106
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33908-9613
Mailing Address - Country:US
Mailing Address - Phone:239-482-8239
Mailing Address - Fax:
Practice Address - Street 1:8801 COLLEGE PARKWAY
Practice Address - Street 2:SUITE 2
Practice Address - City:FT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33919-4882
Practice Address - Country:US
Practice Address - Phone:239-482-8239
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-15
Last Update Date:2012-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLOS7123208VP0014X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208VP0014XAllopathic & Osteopathic PhysiciansPain MedicineInterventional Pain MedicineGroup - Single Specialty