Provider Demographics
NPI:1871732602
Name:NORTH BEACH PAIN & HEALTH CENTER, INC.
Entity type:Organization
Organization Name:NORTH BEACH PAIN & HEALTH CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:GM
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATRUSHEVA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-245-7444
Mailing Address - Street 1:16400 NE 19TH AVE
Mailing Address - Street 2:
Mailing Address - City:NORTH MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33162-4115
Mailing Address - Country:US
Mailing Address - Phone:786-245-7444
Mailing Address - Fax:
Practice Address - Street 1:16400 NE 19TH AVE
Practice Address - Street 2:
Practice Address - City:NORTH MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33162-4115
Practice Address - Country:US
Practice Address - Phone:786-245-7444
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-18
Last Update Date:2009-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLHCC8069261QH0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service