Healthcare Provider Details

I. General information

NPI: 1700976578
Provider Name (Legal Business Name): BROOKSVILLE PAIN MANAGEMENT, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/13/2006
Last Update Date: 08/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5467 COMMERCIAL WAY
SPRING HILL FL
34606-1110
US

IV. Provider business mailing address

5467 COMMERCIAL WAY
SPRING HILL FL
34606-1110
US

V. Phone/Fax

Practice location:
  • Phone: 352-597-7111
  • Fax: 352-597-7171
Mailing address:
  • Phone: 352-597-7111
  • Fax: 352-597-7171

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QP3300X
TaxonomyPain Clinic/Center
License NumberME0067353
License Number StateFL

VIII. Authorized Official

Name: DR. MICHAEL DOYLE COURTNEY
Title or Position: PRESIDENT
Credential: M.D.
Phone: 352-597-7111