NPIMap

Organization Active NPI

Brunswick Pain Treatment Center, LLC

  • Ambulatory Surgical Clinic/Center
  • Brunswick, GA
National Provider Identifier
1154422541
Registry record updated Dec 8, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
Ambulatory Surgical Clinic/CenterTaxonomy code 261QA1903X
License
0411782 Issued in GA
Legal business name
BRUNSWICK PAIN TREATMENT CENTER, LLC
Practice address
1111 Glynco Pkwy
3Rd Floor
Brunswick, GA 31525
Phone
(912) 262-6552
Fax
(912) 262-0112
NPI assigned
Sep 26, 2006
Last updated
Dec 8, 2025By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 8, 2025

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

Authorized official

Name
Shaneka Tinch
Title
RCM Manager
Phone
(469) 458-9222

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Ambulatory Surgical Clinic/Center 261QA1903X 0411782 GA Primary

Addresses

Primary practice location

1111 Glynco Pkwy
3Rd Floor
Brunswick, GA 31525

Mailing address

4960 SW 72ND Ave Ste 405
Miami, FL 33155-5506
Phone (469) 458-9222

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in GA

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
O20041214001030 GA Part B Supplier - Ambulatory Surgical Center 5597722298 Receives reassigned benefits from 5 practitioners
Practice locations: Brunswick, GA

Care Compare: Ambulatory surgical center

Medicare Care Compare
Listed as
Brunswick Pain Treatment Center LLCCCN 11C0001249
Medicare certification status
ActiveFrom the Provider of Services file

Laboratory certificates & supplier records

Derived by NPIMap

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

CLIA laboratory certificates

CLIA numberLaboratoryCertificateExpires
11D1085594Brunswick Pain Treatment Center1111 Glynco Parkway Suite B 3Rd Floor, Brunswick, GA 31525Certificate of waiverJun 22, 2028

National Provider Directory

National Provider Directory

Locations

1111 Glynco Pkwy
Ste 3
Brunswick, GA 31525

Practitioners & affiliated clinicians

Practitioners 12

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

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

{
    "created_epoch": "1159228800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1765152000000",
    "number": "1154422541",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4960 SW 72ND AVE STE 405",
            "city": "MIAMI",
            "state": "FL",
            "postal_code": "331555506",
            "telephone_number": "469-458-9222",
            "fax_number": "540-918-7202"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1111 GLYNCO PKWY",
            "address_2": "3RD FLOOR",
            "city": "BRUNSWICK",
            "state": "GA",
            "postal_code": "31525",
            "telephone_number": "912-262-6552",
            "fax_number": "912-262-0112"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "BRUNSWICK PAIN TREATMENT CENTER, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-09-26",
        "last_updated": "2025-12-08",
        "certification_date": "2025-12-08",
        "status": "A",
        "authorized_official_last_name": "TINCH",
        "authorized_official_first_name": "SHANEKA",
        "authorized_official_title_or_position": "RCM MANAGER",
        "authorized_official_telephone_number": "469-458-9222"
    },
    "taxonomies": [
        {
            "code": "261QA1903X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Ambulatory Surgical",
            "state": "GA",
            "license": "0411782",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brunswick, GA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 8, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
  • Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.