Healthcare Provider Details

I. General information

NPI: 1396978474
Provider Name (Legal Business Name): NATIONAL INJURY CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2009
Last Update Date: 08/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1307 W BUSCH
TAMPA FL
33612
US

IV. Provider business mailing address

1307 W BUSH BLVD.
TAMPA FL
33612
US

V. Phone/Fax

Practice location:
  • Phone: 813-295-6655
  • Fax:
Mailing address:
  • Phone: 813-295-6655
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MIKE MACHIN
Title or Position: BILLING DEPARTMENT
Credential:
Phone: 813-295-6655