Healthcare Provider Details

I. General information

NPI: 1528370020
Provider Name (Legal Business Name): PAIN & URGENT CARE CLINIC PA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2010
Last Update Date: 04/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6802 N ARMENIA AVE
TAMPA FL
33604-5776
US

IV. Provider business mailing address

205 N PLANT AVE
PLANT CITY FL
33563-4731
US

V. Phone/Fax

Practice location:
  • Phone: 813-304-2361
  • Fax: 813-304-2363
Mailing address:
  • Phone: 813-304-2361
  • Fax: 813-304-2363

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberME 105157
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code207RG0300X
TaxonomyGeriatric Medicine (Internal Medicine) Physician
License NumberME 105157
License Number StateFL
# 3
Primary TaxonomyY
Taxonomy Code207RH0002X
TaxonomyHospice and Palliative Medicine (Internal Medicine) Physician
License NumberME 105157
License Number StateFL

VIII. Authorized Official

Name: DR. MIGUEL A MONTOYA
Title or Position: PRESIDENT & DIRECTOR
Credential: MD
Phone: 813-304-2361