Healthcare Provider Details

I. General information

NPI: 1609051150
Provider Name (Legal Business Name): SPINE AND PAIN MEDICINE CENTER PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/03/2008
Last Update Date: 05/16/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8811 STATE ROAD 52 SUITE 21
HUDSON FL
34667-6784
US

IV. Provider business mailing address

8811 STATE ROAD 52 SUITE 21
HUDSON FL
34667-6784
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-2277
  • Fax: 727-861-2062
Mailing address:
  • Phone: 727-861-2277
  • Fax: 727-861-2062

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberME0060231
License Number StateFL

VIII. Authorized Official

Name: DR. DANIEL H BENDER
Title or Position: PRESIDENT
Credential: M.D.
Phone: 727-861-2277