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General NPI Number Information
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NPI Number | 1639456692
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Entity Type | Organization
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Legal Business Name | PAIN AND SPINE CENTERS OF FLORIDA LLC
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Dates
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Enumeration Date | 11/04/2011
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Last Update Date | 07/23/2015
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Provider Practice Location Address
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Address Line | 800 COUNTY ROAD 466
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City | LADY LAKE
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State | FL
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Zip | 32159
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Country | US
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Telephone | 352-343-6900
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Fax |
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Provider Business Mailing Address
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Address Line | 8136 CENTRALIA CT SUITE 103
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City | LEESBURG
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State | FL
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Zip | 34788-3757
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Country | US
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Telephone | 352-343-6900
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Fax |
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Authorized Official
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Title or Position | MEDICAL DOCTOR
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Name | SRIDHAR PINNAMANENI
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Credential | MD
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Telephone | 352-343-6900
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 207RH0003X
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Taxonomy Name | Hematology & Oncology Physician
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 208VP0000X
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Taxonomy Name | Pain Medicine Physician
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License Number |
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License Number State |
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