MEDICARE: PAIN RELIEF CENTER OF ORLANDO, INC

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	:	1720307606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PAIN RELIEF CENTER OF ORLANDO, INC

Provider Business Mailing Address
First Line	:	1704 WOOLCO WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2852
Country	:	US
Telephone Number	:	321-235-1040
Fax Number	:	321-235-1041

Provider Business Practice Location Address
First Line	:	1704 WOOLCO WAY
Second Line	:
City	:	ORLANDO
State	:	FL
Zip	:	32822-2852
Country	:	US
Telephone Number	:	321-235-1040
Fax Number	:	321-235-1041

Authorized Official
Title or Position	:	VICE PRESIDENT
Name	:	MR. LEWIS R SHAPIRO
Credential	:
Telephone Number	:	321-235-1040

Provider Enumeration Date	:	05/18/2010
Last Update Date	:	05/18/2010

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