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NPI Code Detail

MEDICARE: BEHAVIORAL PAIN SPECIALISTS LLC

MEDICARE: BEHAVIORAL PAIN SPECIALISTS LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1207LP2900XPain Medicine (Anesthesiology) Physician
2261QH0100XHealth Service Clinic/Center
3101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1134975881
Entity Type Code : Organization
Provider Name (Legal Business Name) : BEHAVIORAL PAIN SPECIALISTS LLC
Provider Business Mailing Address
First Line : 3005 W EUCLID AVE
Second Line :
City : TAMPA
State : FL
Zip : 33629-8954
Country : US
Telephone Number : 813-508-1859
Fax Number : 888-850-1859
Provider Business Practice Location Address
First Line : 3005 W EUCLID AVE
Second Line :
City : TAMPA
State : FL
Zip : 33629-8954
Country : US
Telephone Number : 813-508-1859
Fax Number : 888-850-1859
Authorized Official
Title or Position : PRESIDENT AND CEO
Name : BOBBY L COATES
Credential : MDIV, LPC,LMFT LMHC
Telephone Number : 813-508-1859
Provider Enumeration Date : 04/24/2024
Last Update Date : 04/24/2024

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Directions to “BEHAVIORAL PAIN SPECIALISTS LLC ” Practice Location

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