MEDICARE: UNIVERSITY PAIN MANAGEMENT CENTER 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	208VP0000X	Pain Medicine Physician

Medicare Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
2	DE1204	OTHER	FL	RAILROAD MEDICARE

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
3	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1730153396
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	UNIVERSITY PAIN MANAGEMENT CENTER INC

Provider Business Mailing Address
First Line	:	PO BOX 46518
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33646-0105
Country	:	US
Telephone Number	:	813-977-2222
Fax Number	:	813-977-4222

Provider Business Practice Location Address
First Line	:	11707 CLUB DR
Second Line	:
City	:	TAMPA
State	:	FL
Zip	:	33612-5521
Country	:	US
Telephone Number	:	813-977-2222
Fax Number	:	813-977-4222

Authorized Official
Title or Position	:	MEDICAL DIRECTOR
Name	:	SHAUKAT H CHOWDHARI
Credential	:	M.D.
Telephone Number	:	813-977-2222

Provider Enumeration Date	:	02/13/2006
Last Update Date	:	12/19/2013

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