Space Coast Spine and Pain Institute LLC

Primary specialty

Pain Medicine (Anesthesiology) PhysicianTaxonomy code 207LP2900X

Legal business name

SPACE COAST SPINE AND PAIN INSTITUTE LLC

Practice address

205 E Nasa Blvd Ste 200
Melbourne, FL 32901-1954

Phone

(321) 361-5619

NPI assigned

Jul 24, 2021

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Sonya Warnick

Title

Administrator

Phone

(321) 432-5480

Specialties & licenses 2

Addresses

Electronic endpoints 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627084800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1627084800000",
    "number": "1093388217",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "285 LANSING ISLAND DR",
            "city": "INDIAN HARBOUR BEACH",
            "state": "FL",
            "postal_code": "329375102",
            "telephone_number": "321-361-5619"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "205 E NASA BLVD STE 200",
            "city": "MELBOURNE",
            "state": "FL",
            "postal_code": "329011954",
            "telephone_number": "321-361-5619"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "SPACE COAST SPINE AND PAIN INSTITUTE LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-07-24",
        "last_updated": "2021-07-24",
        "certification_date": "2021-07-24",
        "status": "A",
        "authorized_official_last_name": "WARNICK",
        "authorized_official_first_name": "SONYA",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "321-432-5480"
    },
    "taxonomies": [
        {
            "code": "207LP2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Anesthesiology, Pain Medicine",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "2081P2900X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Physical Medicine & Rehabilitation, Pain Medicine",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "CONNECT",
            "endpointTypeDescription": "CONNECT URL",
            "endpoint": "Athena",
            "affiliation": "N",
            "address_1": "205 E Nasa Blvd Ste 200",
            "city": "Melbourne",
            "state": "FL",
            "country_code": "US",
            "postal_code": "329011954",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

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• Pain Medicine (Anesthesiology) Physician in Melbourne, FL
• Providers in Melbourne, FL by specialty
• Pain Medicine (Anesthesiology) Physician in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 24, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.