Healthcare Provider Details

I. General information

NPI: 1538258561
Provider Name (Legal Business Name): MARION PAIN MANAGEMENT CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2006
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1737A SE 28TH LOOP
OCALA FL
34471-1079
US

IV. Provider business mailing address

PO BOX 917572
ORLANDO FL
32891-7572
US

V. Phone/Fax

Practice location:
  • Phone: 352-622-1840
  • Fax: 352-622-0137
Mailing address:
  • Phone: 888-877-3850
  • Fax: 631-329-6951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: DR. MANGALA SHETTY
Title or Position: OWNER
Credential: MD
Phone: 352-622-1840