Healthcare Provider Details

I. General information

NPI: 1639464191
Provider Name (Legal Business Name): SARASOTA PAIN MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/13/2011
Last Update Date: 07/01/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5580 BEE RIDGE RD BUILDING B
SARASOTA FL
34233-1505
US

IV. Provider business mailing address

PO BOX 53067
SARASOTA FL
34232-0326
US

V. Phone/Fax

Practice location:
  • Phone: 941-921-3500
  • Fax: 941-921-3300
Mailing address:
  • Phone: 941-921-3500
  • Fax: 941-921-3300

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0000X
TaxonomyPain Medicine Physician
License NumberLC9311
License Number StateFL

VIII. Authorized Official

Name: MR. COURTLAND TWYMAN
Title or Position: PSTD
Credential:
Phone: 941-921-3500