Healthcare Provider Details

I. General information

NPI: 1730163635
Provider Name (Legal Business Name): SEBRING PAIN MANAGEMENT & REHABILITATION CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/05/2005
Last Update Date: 12/11/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9 RYANT BLVD
SEBRING FL
33872-4075
US

IV. Provider business mailing address

9 RYANT BLVD
SEBRING FL
33872-4075
US

V. Phone/Fax

Practice location:
  • Phone: 863-471-1413
  • Fax: 863-471-1416
Mailing address:
  • Phone: 863-471-1413
  • Fax: 863-471-1416

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174400000X
TaxonomySpecialist
License NumberHCC4693
License Number StateFL

VIII. Authorized Official

Name: MR. WITFORD L REID
Title or Position: PRESIDENT
Credential: MD
Phone: 863-471-1413