MEDICARE: VERITAS INTERVENTIONAL PAIN & SPINE INSTITUTE, 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
1	207LP2900X	Pain Medicine (Anesthesiology) Physician	2012028529	MO

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	14Z0T	OTHER	FL	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1295258051
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	VERITAS INTERVENTIONAL PAIN & SPINE INSTITUTE, LLC

Provider Business Mailing Address
First Line	:	13242 FOX GLOVE ST
Second Line	:
City	:	WINTER GARDEN
State	:	FL
Zip	:	34787-4717
Country	:	US
Telephone Number	:	888-488-2702
Fax Number	:

Provider Business Practice Location Address
First Line	:	2209 NORTH BLVD W STE A
Second Line	:
City	:	DAVENPORT
State	:	FL
Zip	:	33837-8903
Country	:	US
Telephone Number	:	863-679-8000
Fax Number	:	863-679-8008

Authorized Official
Title or Position	:	MD
Name	:	DR. NARENDREN NARAYANASAMY
Credential	:	MD
Telephone Number	:	863-679-8000

Provider Enumeration Date	:	07/24/2017
Last Update Date	:	09/20/2017

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