Afa Pain Specialists, Inc
Organization Active NPI Interventional Pain Medicine Physician · Orange Park, FL
NPI 1679964449 · NPPES record last updated Dec 2, 2015
Key facts
- NPI
- 1679964449
- Entity type
- Organization (NPI type 2)
- Primary specialty
- Interventional Pain Medicine Physician 208VP0014X
- License
- ME113190 (FL)
- Legal business name
- AFA PAIN SPECIALISTS, INC
- Practice address
- 728 Blanding Blvd
Suite C
Orange Park, FL 32065-7728 - Phone
- (904) 639-6747
- Fax
- (904) 639-6769
- NPI assigned
- Feb 13, 2015
- Organization subpart
- No
Authorized official
- Name
- Shariq Latif
- Title
- President
- Phone
- (904) 654-3918
Practitioners 1
-
Shariq Latif, M.D.
Laboratory certificates & supplier records
CLIA laboratory certificates
| CLIA number | Laboratory | Certificate | Expires |
|---|---|---|---|
| 10D2094553 | Afa Pain Specialists Inc | Certificate of waiver | Apr 20, 2027 |
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in FL
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| O20150422000512 | FL | Part B Supplier - Clinic/Group Practice | 6901124080 |
Receives reassigned benefits from 1 practitioner Practice locations: Orange Park, FL; Palm Coast, FL |
National Provider Directory
Locations
393 Palm Coast Pkwy SW
Palm Coast, FL 32137
Phone (585) 202-2745
393 Palm Coast Pkwy SW
Unit 1
Palm Coast, FL 32137
391 Palm Coast Pkwy SW
Unit 1
Palm Coast, FL 32137
Phone (904) 639-6747
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pain Medicine (Anesthesiology) Physician |
207LP2900X | ME113190 | FL | |
| Interventional Pain Medicine Physician |
208VP0014X | ME113190 | FL | Yes |
Addresses
Primary practice location
728 Blanding Blvd
Suite C
Orange Park, FL 32065-7728
Mailing address
PO Box 65748
Orange Park, FL 32065-0013
Phone (904) 639-6747
Other providers in Orange Park, FL
- Dawit Adugna
- Advanced Cardiac Diagnostics LLC
- Advanced Cardiovascular Care PLLC
- Advanced Pathways for Mental Health
- Advanced Patient Transportation, Inc.
- Affan Quadri MD, PA
- Affordable Health Center, Inc
- Agape Care, LLC
- Agape Chiropractic LLC
- Agape Doulas LLC
All providers in Orange Park, FL · Interventional Pain Medicine Physician in Florida
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 2, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.