Healthcare Provider Details

I. General information

NPI: 1205979291
Provider Name (Legal Business Name): KETI MEDICAL CENTER & PAIN MANAGEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 08/11/2023
Certification Date: 08/11/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7105 MARINER BLVD
SPRING HILL FL
34609-1048
US

IV. Provider business mailing address

7105 MARINER BLVD
SPRING HILL FL
34609-1048
US

V. Phone/Fax

Practice location:
  • Phone: 352-596-1339
  • Fax: 352-596-8772
Mailing address:
  • Phone: 352-596-1339
  • Fax: 352-596-8772

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208VP0014X
TaxonomyInterventional Pain Medicine Physician
License Number
License Number State

VIII. Authorized Official

Name: SHYAM S SWAIN
Title or Position: PRESIDENT
Credential: MD
Phone: 352-596-1339