Healthcare Provider Details

I. General information

NPI: 1588357891
Provider Name (Legal Business Name): GULF COAST PAINCARE PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/01/2023
Last Update Date: 11/17/2023
Certification Date: 11/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2595 TAMPA RD STE U
PALM HARBOR FL
34684-3132
US

IV. Provider business mailing address

2595 TAMPA RD STE U
PALM HARBOR FL
34684-3132
US

V. Phone/Fax

Practice location:
  • Phone: 727-371-6468
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code208100000X
TaxonomyPhysical Medicine & Rehabilitation Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code2081P0301X
TaxonomyBrain Injury Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL MASSEY
Title or Position: CEO
Credential:
Phone: 727-238-3238