Healthcare Provider Details

I. General information

NPI: 1124058854
Provider Name (Legal Business Name): INTERVENTIONAL PAIN INSTITUTE OF WEST FLORIDA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/05/2006
Last Update Date: 08/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7412 COMMUNITY CT
HUDSON FL
34667-7101
US

IV. Provider business mailing address

7412 COMMUNITY CT
HUDSON FL
34667-7101
US

V. Phone/Fax

Practice location:
  • Phone: 727-861-1000
  • Fax: 727-681-1010
Mailing address:
  • Phone: 727-861-1000
  • Fax: 727-681-1010

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207L00000X
TaxonomyAnesthesiology Physician
License NumberME74355
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License NumberME74355
License Number StateFL

VIII. Authorized Official

Name: MARK HASHIM
Title or Position: MD/OWNER
Credential: MD
Phone: 727-861-1000