Healthcare Provider Details

I. General information

NPI: 1639359474
Provider Name (Legal Business Name): TAMPA PAIN RELIEF CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2007
Last Update Date: 11/09/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8583 W LINEBAUGH AVE
TAMPA FL
33625-3731
US

IV. Provider business mailing address

5501 W GRAY ST
TAMPA FL
33609-1007
US

V. Phone/Fax

Practice location:
  • Phone: 813-872-4492
  • Fax: 813-870-1502
Mailing address:
  • Phone: 813-569-6500
  • Fax: 813-569-6262

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2081P2900X
TaxonomyPain Medicine (Physical Medicine & Rehabilitation) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code207LP2900X
TaxonomyPain Medicine (Anesthesiology) Physician
License Number
License Number State

VIII. Authorized Official

Name: MS. NANCY J CASTELLANA
Title or Position: PAYOR RELATIONS DIRECTOR
Credential:
Phone: 813-569-6500