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General NPI Number Information
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NPI Number | 1700988672
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Entity Type | Organization
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Legal Business Name | PAIN DIAGNOSTIC & MANAGEMENT CENTER LLC
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Dates
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Enumeration Date | 09/02/2006
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Last Update Date | 04/22/2010
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Provider Practice Location Address
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Address Line | 537 E CENTRAL AVE
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City | WINTER HAVEN
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State | FL
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Zip | 33880-3054
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Country | US
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Telephone | 863-293-3656
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Fax | 863-293-7887
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Provider Business Mailing Address
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Address Line | 321 E ROBERTSON ST
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City | BRANDON
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State | FL
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Zip | 33511-5253
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Country | US
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Telephone | 813-685-2191
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Fax | 813-689-8755
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Authorized Official
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Title or Position | BILLING REP
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Name | PEGGY E VENT
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Credential |
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Telephone | 813-685-2191
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | FL
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