MEDICARE: NATIONAL INJURY CENTER 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	261QP3300X	Pain Clinic/Center

General Provider Information

NPI Number	:	1396978474
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL INJURY CENTER LLC

Provider Business Mailing Address
First Line	:	1307 W BUSH BLVD.
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612
Country	:	US
Telephone Number	:	813-295-6655
Fax Number	:

Provider Business Practice Location Address
First Line	:	1307 W BUSCH
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612
Country	:	US
Telephone Number	:	813-295-6655
Fax Number	:

Authorized Official
Title or Position	:	BILLING DEPARTMENT
Name	:	MIKE MACHIN
Credential	:
Telephone Number	:	813-295-6655

Provider Enumeration Date	:	08/24/2009
Last Update Date	:	08/24/2009

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