Healthcare Provider Details

I. General information

NPI: 1487097556
Provider Name (Legal Business Name): PAIN AND SPINE CENTERS OF FLORIDA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2013
Last Update Date: 09/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8136 CENTRALIA CT SUITE 103
LEESBURG FL
34788-3757
US

IV. Provider business mailing address

8136 CENTRALIA CT SUITE 103
LEESBURG FL
34788-3757
US

V. Phone/Fax

Practice location:
  • Phone: 352-343-6900
  • Fax:
Mailing address:
  • Phone: 352-343-6900
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207RX0202X
TaxonomyMedical Oncology Physician
License NumberME99661
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberME100408
License Number StateFL

VIII. Authorized Official

Name: MR. SEAN MCLIN
Title or Position: BILLING MANAGER
Credential:
Phone: 941-312-2831